Doctor Name: | TAMMY GUSTAFSON |
NPI Number: | 1861791303 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LIMHP |
License Number: | LIMHP 1220 |
Business Practice Address: | 201 E 9th St Ste 4 Cozad, NE - 691301851 |
Business Phone Number: | 3085298810 |
Business Fax Number: | |
Mailing Address: | Po Box 83, COZAD |
State: | NE |
Postal Code: | 691300083 |
Phone Number: | 3085298810 |
Fax Number: | |
NPI Enumeration Date: | 03/23/2011 |
NPI Last Update Date: | 07/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LIMHP 1220 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |