Nikia M Gustafson, MSE, LPCC, LADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC00656 Issued in MN

Practice address

15251 Pleasant Valley Rd
Center City, MN 55012-9640

Phone

(651) 213-4525

NPI assigned

Mar 13, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Centerlife Counseling, LLC

  • Mental Health Counselor
  • Centerville, MN
  • NPI 1417283946
  NPD

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

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1811313950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7039 20TH AVE S",
            "city": "CENTERVILLE",
            "state": "MN",
            "postal_code": "550389737",
            "telephone_number": "651-288-0332",
            "fax_number": "651-288-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15251 PLEASANT VALLEY RD",
            "city": "CENTER CITY",
            "state": "MN",
            "postal_code": "550129640",
            "telephone_number": "651-213-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "NIKIA",
        "middle_name": "M",
        "credential": "MSE, LPCC, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-13",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303813",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC00656",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC00656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Boyle Gademsky, MA LADC
• William F Garrison, RPH
• Margaret Gerty
• Sara Jean Giachino, M.A.
• Gordy'S Pharmacy Inc.
• Annalyse Haagenson
• Christian Robert Samuel Haak, MA, LADC.
• Patricia Ann Hall, MA, CLC
• Philip A Hanson, PH.D
• Janaka Eugene Hanvey, M.S.

• Mental Health Counselor in Center City, MN
• Providers in Center City, 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 11, 2019; 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.