Provider Demographics
NPI:1720229578
Name:CATHIE GUM, PSYD, A PSYCHOLOGCIAL CORPORATION
Entity Type:Organization
Organization Name:CATHIE GUM, PSYD, A PSYCHOLOGCIAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHIE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:GUM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-922-1698
Mailing Address - Street 1:9171 WILSHIRE BLVD STE 670
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5517
Mailing Address - Country:US
Mailing Address - Phone:310-922-1698
Mailing Address - Fax:
Practice Address - Street 1:9171 WILSHIRE BLVD STE 670
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5517
Practice Address - Country:US
Practice Address - Phone:310-922-1698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-07
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty