Provider Demographics
NPI:1689141848
Name:LUNDVALL, KATHRYN MARSTON (MS, CRC, LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARSTON
Last Name:LUNDVALL
Suffix:
Gender:F
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SUTTLE ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-8276
Mailing Address - Country:US
Mailing Address - Phone:970-335-2232
Mailing Address - Fax:
Practice Address - Street 1:1125 THREE SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-9033
Practice Address - Country:US
Practice Address - Phone:970-903-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional