Individual
DR. LISA ANN GUSTAVSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1141 E 3900 S, SUITE A170, SALT LAKE CITY, UT 84124-1215
(801) 284-4990
Mailing address
1141 E 3900 S, SUITE A170, SALT LAKE CITY, UT 84124-1215
(801) 284-4990
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
117014-2501
UT
Other
Enumeration date
01/30/2006
Last updated
07/08/2007
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