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General NPI Number Information
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NPI Number | 1851508220
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Entity Type | Individual
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Provider Name | MARY MITCHELL LUNDEEN LP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3701 LAKESHORE DRIVE SUITE 106
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City | NAVARRE
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State | MN
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Zip | 55391
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Country | US
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Telephone | 612-876-1991
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Fax |
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Provider Business Mailing Address
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Address Line | 12876 ORONO RD NW
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City | ELK RIVER
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State | MN
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Zip | 55330-1740
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Country | US
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Telephone | 763-241-9968
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP2696
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License Number State | MN
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