Individual
MR. MICHAEL WILLIAM GILLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
705 WASHINGTON BLVD STE 100, WILLIAMSPORT, PA 17701-5355
(570) 321-6390
(570) 321-6393
Mailing address
705 WASHINGTON BLVD STE 100, WILLIAMSPORT, PA 17701-5355
(570) 321-6390
(570) 321-6393
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS007825L
PA
103TB0200X
Cognitive & Behavioral Psychologist
PS007825L
PA
103TC2200X
Clinical Child & Adolescent Psychologist
PS007825L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001553383
—
PA
Enumeration date
04/14/2006
Last updated
01/28/2025
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