Provider Demographics
NPI:1871921114
Name:GUSTAFSON, NATALIE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 R AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2276
Mailing Address - Country:US
Mailing Address - Phone:360-391-4855
Mailing Address - Fax:
Practice Address - Street 1:13391 AVON ALLEN RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-6904
Practice Address - Country:US
Practice Address - Phone:360-391-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist