Provider Demographics
NPI:1083593099
Name:GUSTAFSON, HOPE MARIE (LMSW)
Entity type:Individual
Prefix:MS
First Name:HOPE
Middle Name:MARIE
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 BEARING WAY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-2301
Mailing Address - Country:US
Mailing Address - Phone:601-466-0024
Mailing Address - Fax:
Practice Address - Street 1:767 BEARING WAY
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-2301
Practice Address - Country:US
Practice Address - Phone:601-466-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM11471104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker