Provider Demographics
NPI:1174374607
Name:DEEPER BOND, PLLC
Entity type:Organization
Organization Name:DEEPER BOND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CEDAR
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LUNDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:218-590-0635
Mailing Address - Street 1:314 W SUPERIOR ST STE 500-1
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1824
Mailing Address - Country:US
Mailing Address - Phone:218-590-0635
Mailing Address - Fax:
Practice Address - Street 1:314 W SUPERIOR ST STE 500-1
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1824
Practice Address - Country:US
Practice Address - Phone:218-590-0635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty