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General NPI Number Information
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NPI Number | 1487811105
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Entity Type | Organization
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Legal Business Name | NUVIEW PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 6120 OREN AVE N
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City | STILLWATER
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State | MN
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Zip | 55082-6155
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Country | US
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Telephone | 651-430-0888
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Fax | 651-430-0889
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Provider Business Mailing Address
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Address Line | 6120 OREN AVE N
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City | STILLWATER
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State | MN
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Zip | 55082-6155
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Country | US
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Telephone | 651-430-0888
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Fax | 651-430-0889
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. DONAE VERBENA GUSTAFSON
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Credential | PSY. D.,L.P.
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Telephone | 651-430-0888
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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 | LP3566
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License Number State | MN
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