Active NPI
Nathaniel William Gump, PH.D.
- Counseling Psychologist
- Corvallis, OR
National Provider Identifier
1265714133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 2967
- Practice address
- 408 SW Monroe Ave Ste M236
Corvallis, OR 97333-7210 - Phone
- (541) 250-0143
- NPI assigned
- Sep 15, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 2738-57 | WI | |
| Counseling Psychologist | 103TC1900X | 2967 | OR | Primary |
Addresses
Primary practice location
408 SW Monroe Ave Ste M236
Corvallis, OR 97333-7210
Mailing address
408 SW Monroe Ave Ste M236
Corvallis, OR 97333-7210
Phone (541) 250-0143
Other practice location 1
W6144 Aerotech Dr
Appleton, WI 54914-7503
Phone (920) 733-2065
Other practice location 2
887 NW Grant Ave
Corvallis, OR 97330-4539
Phone (541) 714-5620
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 2, 2024 through Apr 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2967 | OR | MD | Counseling Psychologist |
| 2738-57 | WI | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571788800000",
"number": "1265714133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 SW MONROE AVE STE M236",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973337210",
"telephone_number": "541-250-0143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 SW MONROE AVE STE M236",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973337210",
"telephone_number": "541-250-0143"
}
],
"practiceLocations": [
{
"address_1": "W6144 Aerotech Dr",
"address_purpose": "LOCATION",
"city": "Appleton",
"state": "WI",
"postal_code": "549147503",
"country_code": "US",
"telephone_number": "920-733-2065",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "887 NW Grant Ave",
"address_purpose": "LOCATION",
"city": "Corvallis",
"state": "OR",
"postal_code": "973304539",
"country_code": "US",
"telephone_number": "541-714-5620",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GUMP",
"first_name": "NATHANIEL",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-15",
"last_updated": "2019-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "WI",
"license": "2738-57",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "OR",
"license": "2967",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.