Provider Information for 1679884605
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RONALD GENTRY M.A., LPC
Sex: Male
NPI: 1679884605
Last Updated: 2010-06-24
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1679884605 | ||||||||||||
| Enumeration Date | 2010-06-24 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 20476 E 47TH ST S BROKEN ARROW, OK 74014-8825 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 3019 E 5TH ST TULSA, OK 74104-3106 United States Phone: 918-720-4506 | Fax: | ||||||||||||
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