Provider Demographics
NPI:1417575572
Name:JOLENE PUNDSACK MS LPCC PLLC
Entity type:Organization
Organization Name:JOLENE PUNDSACK MS LPCC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:PUNDSACK
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPCC
Authorized Official - Phone:320-333-7901
Mailing Address - Street 1:44980 COUNTY ROAD 35
Mailing Address - Street 2:
Mailing Address - City:GREY EAGLE
Mailing Address - State:MN
Mailing Address - Zip Code:56336
Mailing Address - Country:US
Mailing Address - Phone:320-333-7901
Mailing Address - Fax:
Practice Address - Street 1:324 BROADWAY ST STE 206
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1482
Practice Address - Country:US
Practice Address - Phone:320-762-1762
Practice Address - Fax:320-762-1762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty