Provider Demographics
NPI:1538311980
Name:LUNDSTROM, MICHELE LYNN (MA, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:LUNDSTROM
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8435 UNIVERSITY BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-1035
Mailing Address - Country:US
Mailing Address - Phone:515-203-1512
Mailing Address - Fax:
Practice Address - Street 1:8435 UNIVERSITY BLVD STE 9
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1035
Practice Address - Country:US
Practice Address - Phone:515-203-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001237101YM0800X
TX62328101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional