Individual
TERESA CAROL GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
829 HALBERT ST, MALVERN, AR 72104-2607
(501) 332-4400
Mailing address
6092 HIGHWAY 371, BLEVINS, AR 71825-9055
(870) 703-5638
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P0604022
AR
Other
Enumeration date
04/19/2007
Last updated
09/30/2008
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