| NPI | 1003248451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WILLIAM GILLUM Owner/Director 570-321-6390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2025-01-31 |