Basic Information
| Provider Information | |||||||||
| NPI: | 1801013651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUNDGREN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | LADC/MH #956 | ||||||||
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| Mailing Information | |||||||||
| Address1: | RESOURCE MANAGEMENT | ||||||||
| Address2: | 1300 HOPPE BLVD., SUITE 1 | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804367211 | ||||||||
| FaxNumber: | 5802725757 | ||||||||
| Practice Location | |||||||||
| Address1: | 3115 E. ARLINGTON BLVD. | ||||||||
| Address2: | HEALTHY LIFESTYLES | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803326345 | ||||||||
| FaxNumber: | 5804217724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 956 | OK | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 956 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.