1538253133 NPI number — MS. KIMBERLY ANN LUNDHOLM-EADES M.S., LMFT

Table of content: MS. KIMBERLY ANN LUNDHOLM-EADES M.S., LMFT (NPI 1538253133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538253133 NPI number — MS. KIMBERLY ANN LUNDHOLM-EADES M.S., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUNDHOLM-EADES
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLSON
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538253133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7039 20TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55038-9737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-393-2830
Provider Business Mailing Address Fax Number:
651-393-2835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7039 20TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTERVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55038-9737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-393-2830
Provider Business Practice Location Address Fax Number:
651-393-2835
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  942 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 011N6LU . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com