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General NPI Number Information
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NPI Number | 1861622524
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Entity Type | Individual
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Provider Name | KARYN LYNNE GUST-BREY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 2380 N 124TH ST SUITE 101
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City | WAUWATOSA
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State | WI
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Zip | 53226-1071
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Country | US
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Telephone | 414-443-1773
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Fax | 414-443-1747
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Provider Business Mailing Address
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Address Line | 2380 N 124TH ST SUITE 101
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City | WAUWATOSA
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State | WI
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Zip | 53226-1071
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Country | US
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Telephone | 414-443-1773
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Fax | 414-443-1747
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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 | 2235-57
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License Number State | WI
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