Provider Demographics
NPI:1043938673
Name:SUNDBERG, KYLE EDWARD (LPC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:EDWARD
Last Name:SUNDBERG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2613
Mailing Address - Country:US
Mailing Address - Phone:218-325-0069
Mailing Address - Fax:
Practice Address - Street 1:119 4TH ST S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2613
Practice Address - Country:US
Practice Address - Phone:218-325-0069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health