1477578672 NPI number — MRS. ELIZABETH LUND LCSW

Table of content: MRS. ELIZABETH LUND LCSW (NPI 1477578672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477578672 NPI number — MRS. ELIZABETH LUND LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUND
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477578672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1262 W 3050 S.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERRY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-723-8899
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 W 1400 N
Provider Second Line Business Practice Location Address:
STE A LDS FAMILY SERVICES
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-752-5302
Provider Business Practice Location Address Fax Number:
435-753-9007
Provider Enumeration Date:
07/12/2006

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: 1041C0700X , with the licence number:  51911803502 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 51911803501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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