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Contact Information

LISA A GUSTAVSON, PhD
1141 E 3900 S
SUITE A170
SALT LAKE CITY, UT84124-1215
 Phone: 801-284-4990
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Counseling

103TC1900X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for LISA A GUSTAVSON · (Female)

NPI Number 1639140312
Status Active
Credentials PhD
Entity Individual
Enumeration date 01/30/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Not specified
Identifiers
  • UT License # 117014-2501
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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