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General NPI Number Information
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NPI Number | 1063597565
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Entity Type | Individual
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Provider Name | NANCY GAYLE GUSTIN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 1000 S FORT THOMAS AVE
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City | FORT THOMAS
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State | KY
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Zip | 41075-2305
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Country | US
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Telephone | 859-572-6722
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Fax |
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Provider Business Mailing Address
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Address Line | 4460 CARVER WOODS DR STE 103
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City | BLUE ASH
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State | OH
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Zip | 45242-5520
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Country | US
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Telephone | 513-713-5885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6388
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License Number State | OH
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