Provider Demographics
NPI:1467280446
Name:GUST, JAMISON (CADC DP-BA)
Entity type:Individual
Prefix:
First Name:JAMISON
Middle Name:
Last Name:GUST
Suffix:
Gender:F
Credentials:CADC DP-BA
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:
Other - Last Name:GUST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC DP-BA
Mailing Address - Street 1:1804 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-3944
Mailing Address - Country:US
Mailing Address - Phone:616-443-5993
Mailing Address - Fax:
Practice Address - Street 1:842 COLUMBIA AVE E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5449
Practice Address - Country:US
Practice Address - Phone:269-753-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)