Provider Demographics
NPI:1336247493
Name:GENTRY, NONA (LPC)
Entity Type:Individual
Prefix:
First Name:NONA
Middle Name:
Last Name:GENTRY
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 1:123 E AVENUE C
Mailing Address - Street 2:
Mailing Address - City:HEAVENER
Mailing Address - State:OK
Mailing Address - Zip Code:74937-2603
Mailing Address - Country:US
Mailing Address - Phone:918-658-8075
Mailing Address - Fax:866-318-8057
Practice Address - Street 1:123 E AVENUE C
Practice Address - Street 2:
Practice Address - City:HEAVENER
Practice Address - State:OK
Practice Address - Zip Code:74937-2603
Practice Address - Country:US
Practice Address - Phone:918-658-8078
Practice Address - Fax:866-318-8057
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100399640FMedicaid
OK100399640BMedicaid
OK100399640BMedicaid