Individual provider Active NPI

Gwendolyn Bynum, PLPC

  • Professional Counselor
  • Monroe, LA
National Provider Identifier
1053855403
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
9103 Issued in LA
Practice address
2101 Tower Dr
Monroe, LA 71201-5045
Phone
(318) 884-3905
NPI assigned
Dec 5, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 9103 LA
Case Manager/Care Coordinator 171M00000X
Professional Counselor 101YP2500X 9103 LA Primary
Counselor 101Y00000X PLC9103 LA

Addresses

Primary practice location

2101 Tower Dr
Monroe, LA 71201-5045

Mailing address

1162 Oliver Rd Ste 4
Monroe, LA 71201-5757
Phone (318) 340-1535

Other practice location 1

4951 Central Ave
Monroe, LA 71203-6156
Phone (318) 340-1535

Other practice location 2

622 Riverside Dr
Monroe, LA 71201-6211
Phone (318) 980-9453

Other practice location 3

1162 Oliver Rd Ste 4
Monroe, LA 71201-5757
Phone (318) 340-1535

Other practice location 4

413 S Farmerville St
Ruston, LA 71270-4654
Phone (318) 548-1463

Other identifiers 1

IdentifierTypeStateIssuer
1306217062OtherLAMENTAL HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9103LAMDCounselor
PLC9103LAMDCounselor

NPI Registry JSON

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

{
    "created_epoch": "1480896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1053855403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1162 OLIVER RD STE 4",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015757",
            "telephone_number": "318-340-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 TOWER DR",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015045",
            "telephone_number": "318-884-3905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4951 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712036156",
            "country_code": "US",
            "telephone_number": "318-340-1535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "622 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712016211",
            "country_code": "US",
            "telephone_number": "318-980-9453",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1162 Oliver Rd Ste 4",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712015757",
            "country_code": "US",
            "telephone_number": "318-340-1535",
            "fax_number": "318-340-1539",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "413 S Farmerville St",
            "address_purpose": "LOCATION",
            "city": "Ruston",
            "state": "LA",
            "postal_code": "712704654",
            "country_code": "US",
            "telephone_number": "318-548-1463",
            "fax_number": "318-548-9202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BYNUM",
        "first_name": "GWENDOLYN",
        "credential": "PLPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-05",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "LA",
            "license": "9103",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "9103",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "LA",
            "license": "PLC9103",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "1306217062",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.