Provider Demographics
NPI:1659326015
Name:LUNDIN, NATHAN ERIC (LPC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:ERIC
Last Name:LUNDIN
Suffix:
Gender:M
Credentials:LPC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1031A PERUQUE CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2384
Mailing Address - Country:US
Mailing Address - Phone:636-887-3655
Mailing Address - Fax:636-887-3655
Practice Address - Street 1:5551 WINGHAVEN BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3617
Practice Address - Country:US
Practice Address - Phone:636-561-2979
Practice Address - Fax:636-561-2979
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO002492101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499742906Medicaid