Healthcare Provider Details

I. General information

NPI: 1801013651
Provider Name (Legal Business Name): LISA CHRISTINE LUNDGREN LADC/MH #956
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 E. ARLINGTON BLVD. HEALTHY LIFESTYLES
ADA OK
74820
US

IV. Provider business mailing address

RESOURCE MANAGEMENT 1300 HOPPE BLVD., SUITE 1
ADA OK
74820
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-6345
  • Fax: 580-421-7724
Mailing address:
  • Phone: 580-436-7211
  • Fax: 580-272-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number956
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number956
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: