Provider Demographics
NPI:1114104163
Name:WILLIAM S LUNDGREN LLC
Entity Type:Organization
Organization Name:WILLIAM S LUNDGREN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUNDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC CAC III CEAP
Authorized Official - Phone:303-329-2928
Mailing Address - Street 1:1365 COLUMBINE
Mailing Address - Street 2:#104
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206
Mailing Address - Country:US
Mailing Address - Phone:303-329-2928
Mailing Address - Fax:303-329-2917
Practice Address - Street 1:777 GRAND
Practice Address - Street 2:SUITE 304
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203
Practice Address - Country:US
Practice Address - Phone:303-329-2928
Practice Address - Fax:303-329-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3169101YP2500X
PAPS006144L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty