MEDICARE: DEEPER BOND, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1174374607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEEPER BOND, PLLC

Provider Business Mailing Address
First Line	:	314 W SUPERIOR ST STE 500-1
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1824
Country	:	US
Telephone Number	:	218-590-0635
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 W SUPERIOR ST STE 500-1
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1824
Country	:	US
Telephone Number	:	218-590-0635
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CEDAR ROSE LUNDGREN
Credential	:	LPCC
Telephone Number	:	218-590-0635

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	04/01/2024

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Directions to “DEEPER BOND, PLLC ” Practice Location

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