Basic Information
| Provider Information | |||||||||
| NPI: | 1003146036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GENTRY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 NW 66TH ST | ||||||||
| Address2: | |||||||||
| City: | WARR ACRES | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731327765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058342885 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 301 W I 240 SERVICE RD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731397701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056049644 | ||||||||
| FaxNumber: | 4056049689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2010 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CADC 215 | OK | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.