Provider Demographics
NPI:1669678553
Name:LINDBERG, MATTHEW JOHN (LPCC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOHN
Last Name:LINDBERG
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 GARFIELD AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408
Mailing Address - Country:US
Mailing Address - Phone:612-827-2517
Mailing Address - Fax:612-827-8112
Practice Address - Street 1:3033 GARFIELD AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408
Practice Address - Country:US
Practice Address - Phone:612-827-2517
Practice Address - Fax:612-827-8112
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN927970000Medicaid
HP80859OtherHEALTH PARTNERS
MNHP80859OtherHEALTH PARTNERS/ CIGNA
MN411910086OtherCORPHEALTH