Provider Demographics
NPI:1841546280
Name:GUSOVSKY, ANNA (MS, LPCC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GUSOVSKY
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 KIRKWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4642
Mailing Address - Country:US
Mailing Address - Phone:612-423-7032
Mailing Address - Fax:612-341-9079
Practice Address - Street 1:5353 WAYZATA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1316
Practice Address - Country:US
Practice Address - Phone:612-423-7032
Practice Address - Fax:612-341-9079
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional