Stacy Louise Gustafson, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC1066 Issued in MN

Practice address

980 1St St N
Pine River, MN 56474-4508

Phone

(218) 587-8036

NPI assigned

Oct 26, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Changing Strides Therapy LLC

  • Mental Health Counselor
  • Pequot Lakes, MN
  • NPI 1487001400
  NPD Authorized official

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445817600000",
    "number": "1457723769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14639 WHITEBIRCH LN",
            "address_2": "PO BOX 625",
            "city": "CROSSLAKE",
            "state": "MN",
            "postal_code": "564423074",
            "telephone_number": "218-821-5064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 1ST ST N",
            "city": "PINE RIVER",
            "state": "MN",
            "postal_code": "564744508",
            "telephone_number": "218-587-8036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "STACY",
        "middle_name": "LOUISE",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-26",
        "last_updated": "2015-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC1066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Marie Delong
• Julie A Eggers Huber, PSYD, LP
• Steven G Fisker, MD
• Megan Elizabeth Meade Gladen, MD
• Richard Paul Grundtner, LADC
• Healthfirst Chiropractic Inc
• Held & Sauer PLLC
• Jacob John Dale Held, DDS
• Sarah Hendrickson, LPCC
• Owen W. Johnson, DDS

• Mental Health Counselor in Pine River, MN
• Providers in Pine River, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; 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.