Provider Demographics
NPI:1730220047
Name:LUND, DAVE (LIMHP)
Entity type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:LUND
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5430
Mailing Address - Country:US
Mailing Address - Phone:308-534-9271
Mailing Address - Fax:
Practice Address - Street 1:108 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5430
Practice Address - Country:US
Practice Address - Phone:308-534-9271
Practice Address - Fax:308-534-1447
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026240000Medicaid