Healthcare Provider Details

I. General information

NPI: 1467197012
Provider Name (Legal Business Name): CHRISTOPHER LUNDGREN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 LANDA ST STE 300
NEW BRAUNFELS TX
78130-5451
US

IV. Provider business mailing address

819 WATER ST STE 300
KERRVILLE TX
78028-5330
US

V. Phone/Fax

Practice location:
  • Phone: 830-620-6221
  • Fax:
Mailing address:
  • Phone: 830-792-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: