Provider Demographics
NPI:1679235485
Name:GENTILE, KIMBERLEY A
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:A
Last Name:GENTILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 MOUNT VERNON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-8497
Mailing Address - Country:US
Mailing Address - Phone:314-973-4902
Mailing Address - Fax:
Practice Address - Street 1:255 SPENCER RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2494
Practice Address - Country:US
Practice Address - Phone:636-939-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health