Provider Demographics
NPI:1467998104
Name:GENTLES COUSELING SERVICES
Entity Type:Organization
Organization Name:GENTLES COUSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANIEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTLES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:774-242-0312
Mailing Address - Street 1:324 GROVE ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3936
Mailing Address - Country:US
Mailing Address - Phone:774-262-6153
Mailing Address - Fax:774-530-6023
Practice Address - Street 1:324 GROVE ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3936
Practice Address - Country:US
Practice Address - Phone:774-262-6153
Practice Address - Fax:774-530-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9499251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health