Provider Demographics
NPI:1649496233
Name:GENTILE, GENNA LEE (MA, LLMFT)
Entity type:Individual
Prefix:MRS
First Name:GENNA
Middle Name:LEE
Last Name:GENTILE
Suffix:
Gender:F
Credentials:MA, LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 9TH AVE E
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1710
Mailing Address - Country:US
Mailing Address - Phone:218-262-2114
Mailing Address - Fax:
Practice Address - Street 1:2016 9TH AVE E
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1710
Practice Address - Country:US
Practice Address - Phone:218-262-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0883106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist