Healthcare Provider Details

I. General information

NPI: 1922209873
Provider Name (Legal Business Name): KATRINA GRACE GUSTAFSON MS IN COUNSELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE GRACE OLIVEIRA MS IN COUNSELING

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 2ND AVE W
WILLISTON ND
58801-2005
US

IV. Provider business mailing address

316 2ND AVE W
WILLISTON ND
58801-2005
US

V. Phone/Fax

Practice location:
  • Phone: 707-892-1585
  • Fax:
Mailing address:
  • Phone: 707-892-1585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2026-101
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: