Doctor Name: | DR. GUSTAVE FRANK SISON |
NPI Number: | 1073531919 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 26 353 |
Business Practice Address: | 400 Veterans Ave (116b) Biloxi, MS - 395312410 |
Business Phone Number: | 2285234762 |
Business Fax Number: | 2285234768 |
Mailing Address: | 730 Parkwood Dr, LONG BEACH |
State: | MS |
Postal Code: | 395603850 |
Phone Number: | 2285470655 |
Fax Number: | 2285234754 |
NPI Enumeration Date: | 07/18/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 26 353 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |