| Doctor Name: | MARY GUSTAFIK |
| NPI Number: | 1174702922 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 3849 |
| Business Practice Address: | 312 S First Ave Lowr Level Sandpoint, ID - 838641202 |
| Business Phone Number: | 2082637727 |
| Business Fax Number: | 2082637728 |
| Mailing Address: | 202 E Anton Ave Ste 206, COEUR D ALENE |
| State: | ID |
| Postal Code: | 838153779 |
| Phone Number: | 2086676095 |
| Fax Number: | 2086676173 |
| NPI Enumeration Date: | 10/29/2007 |
| NPI Last Update Date: | 10/29/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 3849 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |