| NPI | 1003248451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WILLIAM GILLUM Licensed Psychologist, Owner 570-321-6390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS-007825L) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2013-08-07 |