Individual
RICHARD L. GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4320 DIPLOMACY DR, SUITE 1500, ANCHORAGE, AK 99508-5925
(907) 729-2500
Mailing address
4501 DIPLOMACY DR, ATTN: PROVIDER ENROLLMENT SERVICES, ANCHORAGE, AK 99508-5919
(907) 729-8624
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
527
AK
Other
Enumeration date
05/10/2011
Last updated
07/22/2013
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