Provider Demographics
NPI:1770019762
Name:TENNEY, GARY LEE (PHD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:TENNEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S GILBERT RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2263
Mailing Address - Country:US
Mailing Address - Phone:480-749-4655
Mailing Address - Fax:480-750-1632
Practice Address - Street 1:428 S GILBERT RD
Practice Address - Street 2:SUITE 109
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2263
Practice Address - Country:US
Practice Address - Phone:480-749-4655
Practice Address - Fax:480-750-1632
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4847103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist