Provider Demographics
NPI:1629018213
Name:GENTRY-EPLEY, CAROL 'BETH' (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:'BETH'
Last Name:GENTRY-EPLEY
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 1:119 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1729
Mailing Address - Country:US
Mailing Address - Phone:816-781-1577
Mailing Address - Fax:816-387-2390
Practice Address - Street 1:3505 FREDERICK AVE.
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-387-2636
Practice Address - Fax:816-387-2390
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008806103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical