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Organization
MICHAEL D. GUSACK, MA, LMHC
Active
Organization
MICHAEL D. GUSACK, MA, LMHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARIA TUMANENG (ASSISTANT MANAGER/BILLING)
(850) 384-8648
Entity
Organization
Contact information
Practice address
124 E MIRACLE STRIP PKWY STE 602, MARY ESTHER, FL 32569-1991
(850) 243-7035
(850) 243-8529
Mailing address
PO BOX 879, FORT WALTON BEACH, FL 32549-0879
(850) 243-7035
(850) 243-8529
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NPI
1548285154
FL
Enumeration date
02/05/2019
Last updated
02/05/2019
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