Provider Demographics
NPI:1376228593
Name:LUND, KELLI LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:LYNN
Last Name:LUND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KELLI
Other - Middle Name:LYNN
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:909 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-3003
Mailing Address - Country:US
Mailing Address - Phone:206-351-8285
Mailing Address - Fax:
Practice Address - Street 1:909 BIRCH ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-3003
Practice Address - Country:US
Practice Address - Phone:206-351-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional