Provider Demographics
NPI:1689844508
Name:LUND, GEORGE WILLIAM
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:LUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 INDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-4933
Mailing Address - Country:US
Mailing Address - Phone:415-884-0644
Mailing Address - Fax:
Practice Address - Street 1:303 INDIAN WAY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-4933
Practice Address - Country:US
Practice Address - Phone:415-884-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health