Individual
DR. SCOTT ALLEN GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
551 HATHORN RD, OXFORD, MS 38655-4213
(662) 915-5272
Mailing address
551 HATHORN RD, OXFORD, MS 38655-4213
(662) 915-5272
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
907
NH
103TC0700X
Clinical Psychologist
PS1054
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06Y001129NH01
BLUE CROSS BLUE SHIELD
NH
01
—
201279090 01
HARVARD PILGRIM
NH
05
—
30424636
—
NH
Enumeration date
12/11/2006
Last updated
02/09/2009
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