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NPI Profile for STACY L GUSTAFSON in PEQUOT LAKES, MN.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health |
101YM0800X |
| NPI Number | 1457723769 |
|
| Status | Active | |
| Credentials | LPCC | |
| Entity | Individual | |
| Enumeration date | 10/26/2015 | |
| Last updated | 10/26/2015 - About 11 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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STACY L GUSTAFSON
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STACY L GUSTAFSON, LPCC