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General NPI Number Information
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NPI Number | 1003248451
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Entity Type | Organization
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Legal Business Name | GILLUM PSYCHOLOGICAL & COUNSELING SERVICES
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 705 WASHINGTON BOULEVARD SUITE 100
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-5355
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Country | US
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Telephone | 570-321-6390
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Fax | 570-321-6393
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Provider Business Mailing Address
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Address Line | 705 WASHINGTON BOULEVARD SUITE 100
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-5355
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Country | US
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Telephone | 570-321-6390
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Fax | 570-321-6393
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. MICHAEL WILLIAM GILLUM
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Credential | M.A.
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Telephone | 570-321-6390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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