Provider Demographics
NPI:1649712316
Name:GUMP, AMBER (MA)
Entity type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:
Last Name:GUMP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WILTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3260
Mailing Address - Country:US
Mailing Address - Phone:304-614-6740
Mailing Address - Fax:
Practice Address - Street 1:202 S RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3739
Practice Address - Country:US
Practice Address - Phone:304-637-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1126103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist