Provider Demographics
NPI:1851508220
Name:LUNDEEN, MARY MITCHELL (LP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MITCHELL
Last Name:LUNDEEN
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12876 ORONO RD NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1740
Mailing Address - Country:US
Mailing Address - Phone:763-241-9968
Mailing Address - Fax:
Practice Address - Street 1:3701 LAKESHORE DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:NAVARRE
Practice Address - State:MN
Practice Address - Zip Code:55391
Practice Address - Country:US
Practice Address - Phone:612-876-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2696103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist