STEPHANIE BROOKE GUSTAFSON (NPI# 1891047783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891047783 |
| Entity Type | Individual |
| Full Name | STEPHANIE BROOKE GUSTAFSON |
| Credential | M.A. |
| Practice Address |
2059 Oakhurst Dr. Charleston WV 25309 |
| Mailing Address |
Po Box 58275 Charleston WV 25358-0275 |
| Practice Telephone | 3047445000 |
| Mailing Telephone | 3047445000 |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2012-10-03 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
2594 | TN | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
135 | WV | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043663719 | Stephanie Michelle Gustafson | Registered Nurse | 110 29th Ave N, Suite 201, Nashville, TN 37203-1401 | 2016-07-19 |
| 1497098479 | Stephanie Fliess Gustafson | Pharmacist | 6655 Travis St, Suite 490, Houston, TX 77030-1312 | 2013-03-28 |
| Street Address |
2059 OAKHURST DR. |
| City | CHARLESTON |
| State | WV |
| Zip Code | 25309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376905 | Lovie Bradshaw | Technician | 4823 Tennessee St., South Charleston, WV 25309 | 2020-11-03 |
| 1306447735 | Barbara Mackenzie | Technician | 4224 Kanawha Turnpike, South Charleston, WV 25309 | 2020-11-03 |
| 1548861974 | Sarah Nichols | Technician | 4990 Colonial Park Dr. Apt. F, South Charleston, WV 25309 | 2020-11-03 |
| 1629690177 | Jennifer Mabry-goins | Technician | 4505 River Avenue, S Charleston, WV 25309 | 2020-05-07 |
| 1811537715 | Brandon C Dean | Psychologist | 4857 Macorkle Ave. Sw, South Charleston, WV 25309 | 2020-01-09 |
| 1467096057 | Linda Mullins | Technician | 60 Hayvon Lane, South Charleston, WV 25309 | 2019-11-06 |
| 1831743616 | Ann Myriah Beck | Nurse Practitioner | 4610 Maccorkle Ave Sw # 300, South Charleston, WV 25309 | 2019-07-30 |
| 1942671227 | Edward W Eskew | Family Medicine | 4605 Maccorkle Avenue, Sw, Thspp-psychiatry, South Charleston, WV 25309 | 2015-10-13 |
| 1720468218 | Link Investments LLC | Pharmacy | 5151 Macorkle Avenue, South Charleston, WV 25309 | 2015-06-01 |
| 1366840951 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 304 Southbridge Blvd., S.ccharleston, WV 25309 | 2014-12-12 |
| Find all providers in zip 25309 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087680 | Kerrie Rena Harris | Counselor | 16 Leon Sullivan Way Suite 300, Charleston, WV 25301 | 2020-09-15 |
| 1457974511 | Robert B Woods Jr. | Counselor | 3009 Coopers Basin Cir, Charleston, SC 29414-8029 | 2020-05-24 |
| 1841810439 | Elizabeth Chirles | Counselor | 2005 Frampton Ave, Charleston, SC 29412-2013 | 2020-04-23 |
| 1992335301 | Rebecca Kay Kreutner | Counselor | 3 Broad St Ste 205, Charleston, SC 29401-3054 | 2020-01-24 |
| 1124672282 | Haley E Duncan | Counselor | 3 Broad St Ste 203, Charleston, SC 29401-3054 | 2019-07-27 |
| 1609340942 | Tessa Virginia Pegram Trask | Counselor | 507 Savannah Hwy, Charleston, SC 29407-7209 | 2019-01-21 |
| 1588135834 | Amanda Denise Pendry | Counselor | 921 Churchill Cir, Charleston, WV 25314-1710 | 2018-12-16 |
| 1851862031 | Irene Marie Laganchambers | Counselor | 720 Magnolia Rd Ste 2, Charleston, SC 29407-7094 | 2018-12-16 |
| 1750862231 | Anne Chamberlain Frazier | Counselor | 125 Wappoo Creek Dr # A, Charleston, SC 29412-2163 | 2018-08-23 |
| 1457848400 | William Welker | Counselor | 705 S Park Rd, Charleston, WV 25304-2629 | 2018-04-16 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 25309 |
Please comment or provide details below to improve the information on STEPHANIE BROOKE GUSTAFSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.