Active NPI
Tim Gomersall, L.E.P.
- School Psychologist
- Eureka, CA
National Provider Identifier
1114285772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- LEP 2754
- Practice address
- 525 2ND St
Eureka, CA 95501-5107 - Phone
- (707) 407-7475
- Fax
- (707) 441-1913
- NPI assigned
- May 1, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | LEP 2754 | CA | Primary |
Addresses
Primary practice location
525 2ND St
Eureka, CA 95501-5107
Mailing address
PO Box 6131
Eureka, CA 95502-6131
Phone (707) 407-7475
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
| License | State | Type | Specialty |
|---|---|---|---|
| LEP 2754 | CA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335830400000",
"number": "1114285772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6131",
"city": "EUREKA",
"state": "CA",
"postal_code": "955026131",
"telephone_number": "707-407-7475",
"fax_number": "707-441-1913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 2ND ST",
"city": "EUREKA",
"state": "CA",
"postal_code": "955015107",
"telephone_number": "707-407-7475",
"fax_number": "707-441-1913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMERSALL",
"first_name": "TIM",
"credential": "L.E.P.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-01",
"last_updated": "2012-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "CA",
"license": "LEP 2754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eureka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.