Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | CADC 215 | OK |
NPI | 1003146036 |
---|---|
Provider Name | Ms. Debra Ann Gentry |
First Address | Warr Acres, OK 73132-7765 |
Second Address | Oklahoma City, OK 73139-7701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2010 |
Last Update Date | 14/01/2010 |