National Provider Identifier
Wayne Eric Gustafson, D.MIN.
Wayne Eric Gustafson, D.MIN. is listed in the NPPES registry with a primary specialty of Mental Health Counselor in Ithaca, NY and a listed phone number of (607) 857-0003.
Profile Overview
- NPI
- 1851778757
- Provider Type
- Individual
- Primary Specialty
- Mental Health Counselor
- Enumeration Date
- April 29, 2015
- Last Updated
- April 29, 2015
Practice Location
- 224 Forest Home Dr
- Ithaca, NY 14850-2747
Phone: (607) 857-0003
Mailing Address
- 201 Rachel Carson Way
- Ithaca, NY 14850-8402
Specialties
- Mental Health Counselor (101YM0800X)
- Pastoral Counselor (101YP1600X)
Full Record
- NPI
- 1851778757
- Entity Type
- Individual
- Last Name
- Gustafson
- First Name
- Wayne
- Middle Name
- Eric
- Credential
- D.MIN.
- Mailing Street Address
- 201 Rachel Carson Way
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-8402
- Mailing Country
- US
- Mailing Phone
- (607) 857-0003
- Practice Street Address
- 224 Forest Home Dr
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-2747
- Practice Country
- US
- Practice Phone
- (607) 857-0003
- Enumeration Date
- April 29, 2015
- Last Updated
- April 29, 2015
- Sex
- Male
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Mental Health Counselor (101YM0800X), Pastoral Counselor (101YP1600X)