Provider Demographics
NPI:1205948502
Name:GUSTOFF, BRANDY KAY (MS, LMHP, PLADC)
Entity type:Individual
Prefix:MISS
First Name:BRANDY
Middle Name:KAY
Last Name:GUSTOFF
Suffix:
Gender:F
Credentials:MS, LMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 N 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1856
Mailing Address - Country:US
Mailing Address - Phone:402-573-5111
Mailing Address - Fax:402-573-5019
Practice Address - Street 1:5835 N 90TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1856
Practice Address - Country:US
Practice Address - Phone:402-573-5111
Practice Address - Fax:402-573-5019
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP278101YA0400X
NE2712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250576-00Medicaid
NE47083066230Medicaid
NE47083066228Medicaid
NE47083066226Medicaid
NE85243OtherBXBS PROVIDER NO