Provider Demographics
NPI:1720822323
Name:LUNDBERG, SHARON (LPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LUNDBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9534 NUECES CYN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3577
Mailing Address - Country:US
Mailing Address - Phone:808-291-8477
Mailing Address - Fax:
Practice Address - Street 1:803 CASTROVILLE RD STE 134
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3148
Practice Address - Country:US
Practice Address - Phone:210-436-2339
Practice Address - Fax:210-436-2329
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional