Provider Demographics
NPI:1598823809
Name:LUNDIN, KAREN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:LUNDIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15190 COMMUNITY RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3485
Mailing Address - Country:US
Mailing Address - Phone:228-331-3310
Mailing Address - Fax:228-371-9337
Practice Address - Street 1:15190 COMMUNITY RD
Practice Address - Street 2:SUITE 260
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3485
Practice Address - Country:US
Practice Address - Phone:228-331-3310
Practice Address - Fax:228-371-9337
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003049103TC0700X, 103G00000X, 103T00000X, 103TR0400X
MS51 889103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation