Provider Demographics
NPI:1447378112
Name:LUND, DAVID BURTON (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BURTON
Last Name:LUND
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 W 43RD ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1643
Mailing Address - Country:US
Mailing Address - Phone:612-532-1301
Mailing Address - Fax:612-922-9248
Practice Address - Street 1:2720 W 43RD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1643
Practice Address - Country:US
Practice Address - Phone:612-532-1301
Practice Address - Fax:612-922-9248
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2597103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN023753100Medicaid