Provider Demographics
NPI:1083304117
Name:WESTERLUND, GWENETH J (LPC)
Entity Type:Individual
Prefix:MS
First Name:GWENETH
Middle Name:J
Last Name:WESTERLUND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 RIVERSIDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5332
Mailing Address - Country:US
Mailing Address - Phone:719-337-8396
Mailing Address - Fax:
Practice Address - Street 1:152 RIVERSIDE PARK RD
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5332
Practice Address - Country:US
Practice Address - Phone:719-337-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0013009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional