Provider Demographics
NPI:1538238738
Name:LUNDSTROM WILLCOX, BARBARA (LICSW, LMFT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:LUNDSTROM WILLCOX
Suffix:
Gender:F
Credentials:LICSW, LMFT
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:LUNDSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1821 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2801
Mailing Address - Country:US
Mailing Address - Phone:651-644-8515
Mailing Address - Fax:651-644-3451
Practice Address - Street 1:1821 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2801
Practice Address - Country:US
Practice Address - Phone:651-644-8515
Practice Address - Fax:651-644-3451
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN87141041C0700X
MNMARRIAGE&FAMILY#693174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist