Provider Demographics
NPI:1700972320
Name:LUMBAR, ANGELA ANN (PSYD,LP)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:ANN
Last Name:LUMBAR
Suffix:
Gender:F
Credentials:PSYD,LP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:ANN
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:MN
Mailing Address - Zip Code:55332-0361
Mailing Address - Country:US
Mailing Address - Phone:320-522-1411
Mailing Address - Fax:
Practice Address - Street 1:115 LITCHFIELD AVE SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3476
Practice Address - Country:US
Practice Address - Phone:203-522-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4330103TC2200X, 103TF0200X, 103TM1800X, 103T00000X, 103TP2701X, 103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680002735Medicare PIN