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General NPI Number Information
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NPI Number | 1669556437
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Entity Type | Individual
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Provider Name | WILLIAM THOMAS GUSTAVUS PHD LPC
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2700 HWY 377 SOUTH SUITE 110
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City | BROWNWOOD
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State | TX
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Zip | 76801
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Country | US
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Telephone | 325-642-4883
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Fax | 325-643-6048
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Provider Business Mailing Address
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Address Line | PO BOX 2371
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City | BROWNWOOD
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State | TX
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Zip | 76804
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Country | US
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Telephone | 325-642-4883
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Fax | 325-643-6048
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 12486
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License Number State | TX
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