Provider Demographics
NPI:1871612184
Name:GUSTAFSON, RYAN JON (MA LMFT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JON
Last Name:GUSTAFSON
Suffix:
Gender:M
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 KINGLET DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-6805
Mailing Address - Country:US
Mailing Address - Phone:775-224-0693
Mailing Address - Fax:
Practice Address - Street 1:350 S CENTER ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2103
Practice Address - Country:US
Practice Address - Phone:775-337-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist