Provider Demographics
NPI:1194995944
Name:LUNDGREN, ANDREW (MA, LMFT, LPC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:LUNDGREN
Suffix:
Gender:M
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 SW APPLE WAY STE 320
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1775
Mailing Address - Country:US
Mailing Address - Phone:503-430-5762
Mailing Address - Fax:503-672-7668
Practice Address - Street 1:9725 SW BEAVERTON HILLSDALE HWY STE 230
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4755
Practice Address - Country:US
Practice Address - Phone:503-430-5762
Practice Address - Fax:503-672-7668
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ORT0711106H00000X
ORC2301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500775896Medicaid