Provider Demographics
NPI:1932670403
Name:LUNDGREN, TAMMY (MS)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3514
Mailing Address - Country:US
Mailing Address - Phone:814-934-2704
Mailing Address - Fax:
Practice Address - Street 1:1001 S 1ST ST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5563
Practice Address - Country:US
Practice Address - Phone:814-934-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional