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General NPI Number Information
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NPI Number | 1770196537
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Entity Type | Individual
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Provider Name | ALEXANDRA LUNDSTEEN MS, LMFT, CADC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2020
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Last Update Date | 08/30/2020
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Provider Practice Location Address
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Address Line | 1601 UNIVERSITY DR
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City | ROCKFORD
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State | IL
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Zip | 61107-5317
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Country | US
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Telephone | 815-387-2533
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 N MULFORD RD
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City | ROCKFORD
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State | IL
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Zip | 61107-3874
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 33718
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166001397
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License Number State | IL
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