Provider Demographics
NPI:1801030515
Name:GUSTAFSON, LYNN (PHD LPC)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414-416 ALLEGHENY RIVER BLVD
Mailing Address - Street 2:SUTIE 201
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-1754
Mailing Address - Country:US
Mailing Address - Phone:412-828-0765
Mailing Address - Fax:412-828-5660
Practice Address - Street 1:414-416 ALLEGHENY RIVER BLVD
Practice Address - Street 2:SUTIE 201
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1754
Practice Address - Country:US
Practice Address - Phone:412-828-0765
Practice Address - Fax:412-828-5660
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004333101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor