Provider Demographics
NPI:1437526464
Name:LUND, MELISSA LOUISE (MA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LOUISE
Last Name:LUND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 SE J ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3796
Mailing Address - Country:US
Mailing Address - Phone:760-533-0252
Mailing Address - Fax:
Practice Address - Street 1:3102 SE J ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3796
Practice Address - Country:US
Practice Address - Phone:760-533-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist