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Deactivated NPI 1760873111 Deactivated / Inactive NPI Male Practitioner

Dr. Lee Gustafson , PhD

Psychologist - Forensic • Everett, WA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Lee Gustafson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date February 06, 2015
NPI Deactivation Date July 20, 2020
Total Practice Duration ~5 Years of Practice (2015 – 2020)

Professional Overview & Biography Verified Profile Summary

Dr. Lee Gustafson, PhD was a registered Psychologist - Forensic practicing in Everett, WA. Throughout an active medical career spanning 5 years, Dr. Gustafson provided care at the practice location at 1604 HEWITT AVE until profile deactivation on 2020-07-20.

Practice Location & Contact Primary Location

Practice Address

1604 Hewitt Ave
Suite 615

Everett, WA 982013595

Telephone 4253395106

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist - Forensic in Everett, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 38.0 Yrs
Regional Practice Density
1 Specialists

Practicing in Everett, WA (24 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Psychologist - Forensic Primary Specialty

NUCC Taxonomy Code: 103TF0200X

State License WA 781

A psychologist whose specialty is characterized by activities primarily intended to provide professional psychological expertise within the judicial and legal systems.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
Dr. Steven Johansen , PhD

Psychologist - Clinical

NPI 1225280654

Doctor of Philosophy (Ph.D.)

Dr. Steven Taylor , PhD

Psychologist - Clinical

NPI 1639381098

Doctor of Philosophy (Ph.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated July 20, 2020

Record deactivated on July 20, 2020

NPI Profile Active February 06, 2015

NPI status registered as active in NPPES database

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Updated Practice Location February 06, 2015

Registered at 1604 HEWITT AVE, SUITE 615, EVERETT, WA 982013595 (Tel: 4253395106)

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Updated Business Mailing Address February 06, 2015

Registered at 1604 HEWITT AVE, SUITE 615, EVERETT, WA 982013595 (Tel: 4253395106)

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Provider Name / Credentials Updated February 06, 2015

Recorded as LEE GUSTAFSON, PH.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 06, 2015

Psychologist (License #781 in WA)

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Initial NPI Registration & Enumeration February 06, 2015

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1760873111
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 06, 2015
Last Update: February 06, 2015
Deactivation Date: July 20, 2020

Mailing Address

1604 Hewitt Ave, Suite 615

Everett, WA 982013595

Phone: 4253395106

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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