MEDICARE: EUSTICE COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1700295623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUSTICE COUNSELING LLC

Provider Business Mailing Address
First Line	:	3920 13TH AVE E
Second Line	:	SUITE 6
City	:	HIBBING
State	:	MN
Zip	:	55746-3675
Country	:	US
Telephone Number	:	218-263-7540
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 E HOWARD ST
Second Line	:	SUITE 309
City	:	HIBBING
State	:	MN
Zip	:	55746-1772
Country	:	US
Telephone Number	:	218-966-5385
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GARY D EUSTICE
Credential	:	MS,LP
Telephone Number	:	218-966-5385

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	08/05/2014

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