Organization
GILLUM PSYCHOLOGICAL & COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL W. GILLUM MA (LICENSED PSYCHOLOGIST)
(570) 321-6390
Entity
Organization
Contact information
Practice address
454 PINE ST, SUITE 1B, WILLIAMSPORT, PA 17701-6200
(570) 321-6390
(570) 321-6393
Mailing address
454 PINE ST, SUITE 1B, WILLIAMSPORT, PA 17701-6200
(570) 321-6390
(570) 321-6393
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS007825L
PA
104100000X
Social Worker
SW129735
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028463370001
—
PA
Enumeration date
04/25/2014
Last updated
04/25/2014
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