Basic Information
| Provider Information | |||||||||
| NPI: | 1245611300 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUND | ||||||||
| FirstName: | SHAINE | ||||||||
| MiddleName: | ORVELL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10476 PLATINUM DR | ||||||||
| Address2: | |||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460606124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652895437 | ||||||||
| FaxNumber: | 7657517999 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 W KILGORE AVE | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473044810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652895437 | ||||||||
| FaxNumber: | 7657517999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2015 | ||||||||
| LastUpdateDate: | 06/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | IN | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.