Provider Demographics
NPI:1306474036
Name:GUNDERSON, NATASHA MARIE (LADC, LPCC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:LADC, LPCC
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:MARIE
Other - Last Name:PRANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6043 HUDSON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1019
Mailing Address - Country:US
Mailing Address - Phone:651-348-5594
Mailing Address - Fax:651-925-8201
Practice Address - Street 1:6043 HUDSON RD STE 200
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1019
Practice Address - Country:US
Practice Address - Phone:651-348-5594
Practice Address - Fax:651-925-8201
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2377101YM0800X
MN304953101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)