Provider Demographics
NPI:1225236250
Name:MARGARET GUSTAVSON MFT
Entity Type:Organization
Organization Name:MARGARET GUSTAVSON MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUSTAVSON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:805-480-2622
Mailing Address - Street 1:2000 WHEELWRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5700
Mailing Address - Country:US
Mailing Address - Phone:805-480-2622
Mailing Address - Fax:805-480-2622
Practice Address - Street 1:2000 WHEELWRIGHT LN
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-5700
Practice Address - Country:US
Practice Address - Phone:805-480-2622
Practice Address - Fax:805-480-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42546106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty