Healthcare Provider Details

I. General information

NPI: 1578698338
Provider Name (Legal Business Name): STEPHANIE L LUND L.M.F.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 ETNA ST STE 55
SAINT PAUL MN
55106-5848
US

IV. Provider business mailing address

3632 PASCAL AVE
ARDEN HILLS MN
55112-6905
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-4804
  • Fax: 651-254-9238
Mailing address:
  • Phone: 612-558-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1472
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: