Healthcare Provider Details

I. General information

NPI: 1780952820
Provider Name (Legal Business Name): JOEL T GUSTAFSON LPC., LCMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2011
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 W 95TH ST STE 100
OVERLAND PARK KS
66212-1434
US

IV. Provider business mailing address

9200 GLENWOOD ST STE 103
OVERLAND PARK KS
66212-1304
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-3150
  • Fax:
Mailing address:
  • Phone: 913-647-8092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2241
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2735
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: