Individual provider · Type 1 NPI
Stacy Louise Gustafson, LPCC
Mental Health Counselor · Pine River, MN
NPI number
1457723769
Active
Practice location
980 1st St N
Pine River, MN 56474-4508
Mailing address
14639 Whitebirch Ln, PO Box 625
Crosslake, MN 56442-3074
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor Primary | 101YM0800X | CC1066 (MN) |
Mental Health Counselor: Definition to come...
About NPI 1457723769
Stacy Louise Gustafson, LPCC's National Provider Identifier is 1457723769, issued on Oct 26, 2015. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Pine River, MN. The record was last updated on Oct 26, 2015.