Provider Demographics
NPI:1588354856
Name:LUND, SAMANTHA SUSAN (MA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SUSAN
Last Name:LUND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 NW HIDDEN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-2716
Mailing Address - Country:US
Mailing Address - Phone:816-728-9408
Mailing Address - Fax:
Practice Address - Street 1:7329 BROADWAY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1357
Practice Address - Country:US
Practice Address - Phone:816-561-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health