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General NPI Number Information
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NPI Number | 1871612184
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Entity Type | Individual
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Provider Name | RYAN JON GUSTAFSON M.A. LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 350 S CENTER ST
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City | RENO
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State | NV
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Zip | 89501-2103
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Country | US
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Telephone | 775-337-4401
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 KINGLET DR
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City | SPARKS
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State | NV
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Zip | 89441-6805
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Country | US
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Telephone | 775-224-0693
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 01050
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License Number State | NV
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