Individual
JERI GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2620 N 140TH AVE, GOODYEAR, AZ 85395-2437
(623) 536-7956
Mailing address
2620 N 140TH AVE STE 101, GOODYEAR, AZ 85395-2437
(623) 536-7956
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-005288
AZ
103TC1900X
Counseling Psychologist
PSY-005288
AZ
103TF0200X
Forensic Psychologist
PSY-005288
AZ
103TP2701X
Group Psychotherapy Psychologist
PSY-005288
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
09/28/2012
Last updated
03/17/2022
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