Healthcare Provider Details

I. General information

NPI: 1356745541
Provider Name (Legal Business Name): GUMM PSYCHOLOGICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2014
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 NORWOOD PLZ SUITE 112
HURST TX
76054-3720
US

IV. Provider business mailing address

1848 NORWOOD PLZ SUITE 112
HURST TX
76054-3720
US

V. Phone/Fax

Practice location:
  • Phone: 817-282-6655
  • Fax: 817-282-6657
Mailing address:
  • Phone: 817-282-6655
  • Fax: 817-282-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: RANEE BEATY GUMM
Title or Position: PSYCHOLOGIST/OWNER
Credential: PHD
Phone: 817-282-6655