Provider Demographics
NPI:1225620966
Name:HUSTAD, MYLES CULVER
Entity type:Individual
Prefix:
First Name:MYLES
Middle Name:CULVER
Last Name:HUSTAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HOWARD ST STE R
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:509-934-4005
Mailing Address - Fax:509-934-4006
Practice Address - Street 1:5306 93RD PL SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-3610
Practice Address - Country:US
Practice Address - Phone:509-934-4005
Practice Address - Fax:509-934-4006
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12868160-3902106H00000X
WAMK61645925106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist