Provider Demographics
NPI:1700972650
Name:CARA LUNDEEN PSYD LP LLC
Entity Type:Organization
Organization Name:CARA LUNDEEN PSYD LP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LP
Authorized Official - Phone:651-645-5885
Mailing Address - Street 1:821 RAYMOND AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1509
Mailing Address - Country:US
Mailing Address - Phone:651-645-5885
Mailing Address - Fax:651-645-1403
Practice Address - Street 1:821 RAYMOND AVE STE 140
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1509
Practice Address - Country:US
Practice Address - Phone:651-645-5885
Practice Address - Fax:651-645-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN89G22LUOtherBLUE CROSS BLUE SHEILD OF MN
MN522410100Medicaid
MN522410100Medicaid