Provider Demographics
NPI:1316034770
Name:LUNDGREN, KAREN M (LPCP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:LPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-0222
Mailing Address - Country:US
Mailing Address - Phone:406-853-1197
Mailing Address - Fax:406-234-9333
Practice Address - Street 1:2200 BOX ELDER ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2899
Practice Address - Country:US
Practice Address - Phone:406-853-1197
Practice Address - Fax:406-234-9333
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1232101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT743040OtherBLUECROSS BLUESHIELD
MT0256972Medicaid