Healthcare Provider Details

I. General information

NPI: 1669678553
Provider Name (Legal Business Name): MATTHEW JOHN LINDBERG LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NORTHWOODS DR
SAINT PAUL MN
55112-6966
US

IV. Provider business mailing address

3033 GARFIELD AVENUE SOUTH
MINNEAPOLIS MN
55408
US

V. Phone/Fax

Practice location:
  • Phone: 651-787-9600
  • Fax:
Mailing address:
  • Phone: 612-827-2517
  • Fax: 612-827-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00072
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: