Provider Demographics
NPI:1295164861
Name:LUNDGREN, GEORGIA C (JD, MFT)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:C
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:JD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14906 E CAROLINA PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4727
Mailing Address - Country:US
Mailing Address - Phone:720-810-2255
Mailing Address - Fax:
Practice Address - Street 1:438 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-4754
Practice Address - Country:US
Practice Address - Phone:720-810-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist