Individual
MR. JAN C GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
9322 E 41ST ST, RM 257, TULSA, OK 74145-3721
(918) 628-2708
Mailing address
9322 E 41ST, RM 257, TULSA, OK 74145-6106
(918) 628-2708
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1470
OK
Other
Enumeration date
08/12/2006
Last updated
10/07/2010
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