Gustafson, Scott Allen

Gustafson, Scott Allen is an individual health care provider with primary practice located at 551 Hathorn Rd , Oxford MS 38655-4213. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Gustafson, Scott Allen can be contacted via phone (662) 915-5272.

Contact Information

Primary practice address
551 Hathorn Rd Oxford MS 38655-4213
Phone: (662) 915-5272
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 907 New Hampshire
Behavioral Health & Social Service Providers / Clinical 103TC0700X PS1054 Maine

Profile Details

NPI number 1407916216
LBN Legal business name Gustafson, Scott Allen
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 11th, 2006
Last updated Feb 9th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407916216 NPPES
New Hampshire Other 06Y001129NH01 BLUE CROSS BLUE SHIELD
New Hampshire Other 201279090 01 BLUE CROSS BLUE SHIELD
New Hampshire MEDICAID 30424636 BLUE CROSS BLUE SHIELD

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