MEDICARE: SUZANNE LUNDGREN LPC

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	LPC1667	AZ

General Provider Information

NPI Number	:	1912060203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE LUNDGREN LPC

Provider Business Mailing Address
First Line	:	1316 W PASADENA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2113
Country	:	US
Telephone Number	:	602-266-3516
Fax Number	:	602-776-0881

Provider Business Practice Location Address
First Line	:	1316 W PASADENA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2113
Country	:	US
Telephone Number	:	602-266-3516
Fax Number	:	602-776-0881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	02/14/2014

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