Active NPI
Gary D Eustice, MS LP
- Clinical Psychologist
- Hibbing, MN
National Provider Identifier
1962503110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP2919
- Practice address
- 302 E Howard St
Suite 309
Hibbing, MN 55746-1772 - Phone
- (218) 966-5385
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP2919 | MN | Primary |
Addresses
Primary practice location
302 E Howard St
Suite 309
Hibbing, MN 55746-1772
Mailing address
3920 13TH Ave E
Suite 6
Hibbing, MN 55746-3675
Phone (218) 263-7540
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160553400 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP2919 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eustice Counseling LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychologist
- Hibbing, MN
- NPI 1700295623
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404864000000",
"number": "1962503110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3920 13TH AVE E",
"address_2": "SUITE 6",
"city": "HIBBING",
"state": "MN",
"postal_code": "557463675",
"telephone_number": "218-263-7540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 E HOWARD ST",
"address_2": "SUITE 309",
"city": "HIBBING",
"state": "MN",
"postal_code": "557461772",
"telephone_number": "218-966-5385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EUSTICE",
"first_name": "GARY",
"middle_name": "D",
"credential": "MS LP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2014-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP2919",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "160553400",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hibbing, MN
- Michelle Engbretson
- Michael R. Enich, DDS
- Melissa Erickson
- Tiffany Linda Espe, PHARM D
- Eustice Counseling LLC
- Eye Clinic North, Professional Association
- Kimberly Ann Fagan
- Michelle Dawn Fairbanks, ADULT FOSTER CARE
- Fairview Health Services (Fairview Hibbing Home Medical Equipment)
- Fairview Pharmacy Services LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.