Provider Demographics
NPI:1114053436
Name:LUNDBERG, JAMES A (MS,LIMHP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:LUNDBERG
Suffix:
Gender:M
Credentials:MS,LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 PACIFIC ST STE 305
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5405
Mailing Address - Country:US
Mailing Address - Phone:402-393-8277
Mailing Address - Fax:
Practice Address - Street 1:7602 PACIFIC ST STE 305
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5405
Practice Address - Country:US
Practice Address - Phone:402-393-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470726879-27Medicaid
NE470726879Medicare UPIN