Scott Allen Gustafson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

907 Issued in NH

Practice address

551 Hathorn Rd
Oxford, MS 38655-4213

Phone

(662) 915-5272

NPI assigned

Dec 11, 2006

Last updated

Feb 9, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University of Mississippi

  • Community/Behavioral Health Agency
  • University, MS
  • NPI 1962618223
  Authorized official Same address or phone
• Mount Washington Valley Psychological Services, LLC

  • Psychologist
  • Conway, NH
  • NPI 1861600405

  Clinical

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234137600000",
    "number": "1407916216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "551 HATHORN RD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386554213",
            "telephone_number": "662-915-5272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 HATHORN RD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386554213",
            "telephone_number": "662-915-5272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "SCOTT",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2009-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NH",
            "license": "907",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS1054",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "06Y001129NH01",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30424636",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "201279090 01",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olivia Griffin
• Rachaell Mariah Griffin, BA
• Gulf Shores Radiology Assoicates
• Gumtree Medical Clinic, PLLC (The Kidney Clinic of Oxford, PLLC)
• Mark Gunn, MD
• Abigail C Haas, MA,CCC-SLP
• Jennifer Hadaway, MASTERS DEGREE
• Melissa L Hadskey, BA
• Ginia Dunn Hairston, MSW
• Gregory J Hale, MD

• Clinical Psychologist in Oxford, MS
• Providers in Oxford, MS by specialty
• Clinical Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.