Individual
STACY LOUISE GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
980 1ST ST N, PINE RIVER, MN 56474-4508
(218) 587-8036
Mailing address
14639 WHITEBIRCH LN, PO BOX 625, CROSSLAKE, MN 56442-3074
(218) 821-5064
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC1066
MN
Other
Enumeration date
10/26/2015
Last updated
10/26/2015
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