Provider Demographics
NPI:1275601791
Name:BENTZ, GINA L (PSYD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:L
Last Name:BENTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N MARR RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6660
Mailing Address - Country:US
Mailing Address - Phone:812-314-3400
Mailing Address - Fax:812-378-8367
Practice Address - Street 1:1260 E BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-8343
Practice Address - Country:US
Practice Address - Phone:812-346-4468
Practice Address - Fax:812-378-8367
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist