| NPI | 1891115119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL W. GILLUM Licensed Psychologist 570-321-6390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS007825L) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW129735) |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2014-04-25 |