Provider Demographics
NPI:1144495888
Name:LUNDGREN, WILLIAM SMITH (LPC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SMITH
Last Name:LUNDGREN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1365 COLUMBINE ST
Mailing Address - Street 2:#104
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206
Mailing Address - Country:US
Mailing Address - Phone:303-329-2928
Mailing Address - Fax:303-329-2917
Practice Address - Street 1:777 GRANT ST
Practice Address - Street 2:SUITE 304
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203
Practice Address - Country:US
Practice Address - Phone:303-329-2928
Practice Address - Fax:303-329-2917
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional