Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | LPP 0124 | MN |
Y | 101YP2500X | Professional Counselor | LPC00626 | MN |
NPI | 1003081779 |
---|---|
Provider Name | Joseph P. Sundeen |
First Address | Saint Paul, MN 55107-1801 |
Second Address | Saint Paul, MN 55107-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 13/11/2008 |