Provider Demographics
NPI:1336578145
Name:LUND, REBECCA ANN (LPCC, RPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:LUND
Suffix:
Gender:F
Credentials:LPCC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8011 34TH AVENUE SOUTH
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425
Mailing Address - Country:US
Mailing Address - Phone:612-655-6266
Mailing Address - Fax:
Practice Address - Street 1:8011 34TH AVENUE SOUTH
Practice Address - Street 2:SUITE 206
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425
Practice Address - Country:US
Practice Address - Phone:612-568-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health