Provider Demographics
NPI:1588797591
Name:GENTSCH, TINA M (LPC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:GENTSCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 S STAPLES ST STE 230
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3800
Mailing Address - Country:US
Mailing Address - Phone:361-985-1541
Mailing Address - Fax:361-985-0001
Practice Address - Street 1:5934 S STAPLES ST STE 230
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3800
Practice Address - Country:US
Practice Address - Phone:361-985-1541
Practice Address - Fax:361-985-0001
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61724101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1883720-0102Medicaid