Provider Demographics
NPI:1780952820
Name:GUSTAFSON, JOEL T (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:T
Last Name:GUSTAFSON
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7381 W 133RD ST STE 260
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4750
Mailing Address - Country:US
Mailing Address - Phone:913-647-8092
Mailing Address - Fax:
Practice Address - Street 1:7381 W 133RD ST STE 260
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-4750
Practice Address - Country:US
Practice Address - Phone:913-647-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1248106H00000X
KS2241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist