Provider Demographics
NPI:1205844271
Name:GUMM, WILLIAM BOAZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BOAZ
Last Name:GUMM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 NORWOOD PLZ
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3720
Mailing Address - Country:US
Mailing Address - Phone:817-282-6655
Mailing Address - Fax:817-282-6657
Practice Address - Street 1:124 W HARWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-7016
Practice Address - Country:US
Practice Address - Phone:817-576-4222
Practice Address - Fax:817-576-2200
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2649103T00000X
TX22649103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist