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General NPI Number Information
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NPI Number | 1477659290
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Entity Type | Individual
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Provider Name | KAY MARIE GUSTAFSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 2501 CAPEHART RD
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City | OFFUTT AFB
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State | NE
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Zip | 68113-1043
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Country | US
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Telephone | 402-294-7411
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Fax | 402-294-7085
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Provider Business Mailing Address
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Address Line | 1700 SKYLINE DR
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City | ELKHORN
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State | NE
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Zip | 68022-1741
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Country | US
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Telephone | 402-658-2415
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Fax | 402-333-2298
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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 | 69
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 069
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License Number State | NE
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