NPIMap

Organization Active NPI

Gillum Psychological & Counseling Services

  • Cognitive & Behavioral Psychologist
  • Williamsport, PA
National Provider Identifier
1003248451
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
Legal business name
GILLUM PSYCHOLOGICAL & COUNSELING SERVICES
Practice address
705 Washington Boulevard
Suite 100
Williamsport, PA 17701-5355
Phone
(570) 321-6390
Fax
(570) 321-6393
NPI assigned
Aug 7, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael William Gillum, M.A.NPI 1194789180
Title
Owner/Director
Phone
(570) 321-6390

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X Primary
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X

Addresses

Primary practice location

705 Washington Boulevard
Suite 100
Williamsport, PA 17701-5355

Mailing address

705 Washington Boulevard
Suite 100
Williamsport, PA 17701-5355
Phone (570) 321-6390

Other identifiers 1

IdentifierTypeStateIssuer
001553383MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Gillum Psychological and Counseling Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

454 Pine St
Ste 1B
Williamsport, PA 17701
Phone (570) 321-6390

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738281600000",
    "number": "1003248451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 WASHINGTON BOULEVARD",
            "address_2": "SUITE 100",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177015355",
            "telephone_number": "570-321-6390",
            "fax_number": "570-321-6393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 WASHINGTON BOULEVARD",
            "address_2": "SUITE 100",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177015355",
            "telephone_number": "570-321-6390",
            "fax_number": "570-321-6393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILLUM PSYCHOLOGICAL & COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-07",
        "last_updated": "2025-01-31",
        "status": "A",
        "authorized_official_last_name": "GILLUM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "570-321-6390",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001553383",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.