Provider Demographics
NPI:1134275738
Name:LUNDEN, CHARLES STAFFORD (MS LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:STAFFORD
Last Name:LUNDEN
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUC
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-722-9631
Mailing Address - Fax:520-722-9676
Practice Address - Street 1:6151 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUC
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-722-9631
Practice Address - Fax:520-722-9676
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist