Provider Demographics
NPI:1558167817
Name:GENTRY, SARA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:GENTRY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 NORRIS CT
Mailing Address - Street 2:
Mailing Address - City:BRADY
Mailing Address - State:NE
Mailing Address - Zip Code:69123-2727
Mailing Address - Country:US
Mailing Address - Phone:308-520-3270
Mailing Address - Fax:
Practice Address - Street 1:225 NORRIS CT
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:NE
Practice Address - Zip Code:69123-2727
Practice Address - Country:US
Practice Address - Phone:308-520-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22051041C0700X
NE5934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical