Provider Demographics
NPI:1437711611
Name:LUNDGREN, JEFFREY ALVIN (CMHC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALVIN
Last Name:LUNDGREN
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMHC
Mailing Address - Street 1:1371 E 1700 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3745
Mailing Address - Country:US
Mailing Address - Phone:303-810-2222
Mailing Address - Fax:
Practice Address - Street 1:4055 S 700 E STE 103
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84107-2508
Practice Address - Country:US
Practice Address - Phone:801-874-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11805165-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health