Organization
CHANGING STRIDES THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY LOUISE GUSTAFSON LPCC (COUNSELOR)
(218) 833-7636
Entity
Organization
Contact information
Practice address
10010 STRAWBERRY LAKE RD, PEQUOT LAKES, MN 56472-2291
(218) 833-7636
(218) 543-4394
Mailing address
PO BOX 625, CROSSLAKE, MN 56442-0625
(218) 833-7636
(218) 543-4394
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC01066
MN
Other
Enumeration date
05/19/2016
Last updated
12/04/2024
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