Provider Demographics
NPI:1912060203
Name:LUNDGREN, SUZANNE (LPC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:LUNDGREN
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 1:1316 W PASADENA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2113
Mailing Address - Country:US
Mailing Address - Phone:602-266-3516
Mailing Address - Fax:602-776-0881
Practice Address - Street 1:1316 W PASADENA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2113
Practice Address - Country:US
Practice Address - Phone:602-266-3516
Practice Address - Fax:602-776-0881
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC1667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health