Provider Demographics
NPI:1982242079
Name:ANDREA BECK-LUNDSKOW LLC
Entity type:Organization
Organization Name:ANDREA BECK-LUNDSKOW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDSKOW
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-308-7947
Mailing Address - Street 1:1145 EASTWOOD AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3579
Mailing Address - Country:US
Mailing Address - Phone:616-308-7947
Mailing Address - Fax:
Practice Address - Street 1:4070 LAKE DR SE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8294
Practice Address - Country:US
Practice Address - Phone:616-213-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)