Provider Demographics
NPI:1558543165
Name:LUNDELL, STACY RENAE (LMFT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:RENAE
Last Name:LUNDELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 BIELENBERG DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1707
Mailing Address - Country:US
Mailing Address - Phone:651-259-9700
Mailing Address - Fax:651-259-9780
Practice Address - Street 1:659 BIELENBERG DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:512-599-7106
Practice Address - Fax:651-259-9780
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1555106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist