Individual
LISA GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., PLLC
Contact information
Practice address
200 E MAIN AVE, SUITE 202, BISMARCK, ND 58501-3857
(701) 400-5472
Mailing address
200 E MAIN AVE, SUITE 202, BISMARCK, ND 58501-3857
(701) 400-5472
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
474
ND
Other
Enumeration date
04/08/2013
Last updated
10/27/2013
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