Lisa Kay Gustafson, MS/LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.004529 Issued in IL

Practice address

424 W Madison St
Ottawa, IL 61350-2833

Phone

(815) 431-3022

Fax

(815) 433-3980

NPI assigned

Jul 10, 2008

Last updated

Jul 10, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mendota Community HospitalGroup PAC ID 2264335777, 51 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mendota Community Hospital

  dba OSF Medical Group-Mendota

  • Family Medicine Physician
  • Mendota, IL
  • NPI 1407872997
  Medicare reassignment Care Compare group NPD
• Youth Service Bureau of Illinois Valley

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ottawa, IL
  • NPI 1164757266
  Authorized official Same address or phone
• Mendota Community Hospital

  dba OSF Healthcare - Medical Group - Granville

  • Rural Health Clinic/Center
  • Granville, IL
  • NPI 1225877590
  NPD
• Mendota Community Hospital

  dba OSF Saint Paul Medical Center

  • Emergency Medicine Physician
  • Mendota, IL
  • NPI 1417973900
  NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  NPD (past)

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215648000000",
    "number": "1962666875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 W MADISON ST",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613502833",
            "telephone_number": "815-431-3022",
            "fax_number": "815-433-3980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 W MADISON ST",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613502833",
            "telephone_number": "815-431-3022",
            "fax_number": "815-433-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "LISA",
        "middle_name": "KAY",
        "name_prefix": "Ms.",
        "credential": "MS/LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-10",
        "last_updated": "2008-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.004529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Matthew Gretencord, D.C.
• Rodney Arthur Griffis, CRNA
• John Christian Grimm
• Gueorgui S Gueorguiev, M.D.
• Raul V Guerrero, MD
• Danuta Gwarnicka, MD
• Kathryn Harris, PTA
• Brittany Noel Marie Harzhiem, DT
• Ashlee Herbold
• Heritage Woods of Ottawa

• Professional Counselor in Ottawa, IL
• Providers in Ottawa, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.