Provider Demographics
NPI:1659634038
Name:DAMBORG, DONALD (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:DAMBORG
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 3RD ST S APT 101
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1874
Mailing Address - Country:US
Mailing Address - Phone:831-869-6269
Mailing Address - Fax:
Practice Address - Street 1:19230 EVANS ST NW STE 202A
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1561
Practice Address - Country:US
Practice Address - Phone:763-525-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor