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NPI Code Detail

MEDICARE: MRS. KIMBERLY LUNDE MA, LMFT

MEDICARE: MRS. KIMBERLY LUNDE MA, LMFT
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
1106H00000XMarriage & Family Therapist2573MN

General Provider Information

NPI Number : 1699188342
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY LUNDE MA, LMFT
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW
Second Line : SUITE 110
City : NEW BRIGHTON
State : MN
Zip : 55112-1786
Country : US
Telephone Number : 651-379-1718
Fax Number : 651-379-1738
Provider Business Practice Location Address
First Line : 332 W SUPERIOR ST STE 300
Second Line :
City : DULUTH
State : MN
Zip : 55802-1844
Country : US
Telephone Number : 218-722-4379
Fax Number : 218-722-4333
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2014
Last Update Date : 07/01/2014

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