Healthcare Provider Details

I. General information

NPI: 1104834175
Provider Name (Legal Business Name): RANEE BEATY GUMM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W HARWOOD RD STE A
HURST TX
76054-7016
US

IV. Provider business mailing address

1848 NORWOOD PLAZA SUITE 112
HURST TX
76054-3751
US

V. Phone/Fax

Practice location:
  • Phone: 817-576-4222
  • Fax: 817-576-2200
Mailing address:
  • Phone: 817-282-6655
  • Fax: 817-282-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number22341
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1145
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number23241
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: