Provider Demographics
NPI:1487847133
Name:LUNDIN, ERIC CLIFFORD (MA,,LP)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:CLIFFORD
Last Name:LUNDIN
Suffix:
Gender:M
Credentials:MA,,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5195
Mailing Address - Country:US
Mailing Address - Phone:507-332-6241
Mailing Address - Fax:507-332-6247
Practice Address - Street 1:320 3RD ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5195
Practice Address - Country:US
Practice Address - Phone:507-332-6241
Practice Address - Fax:507-332-6247
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2379103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist