| Doctor Name: | PHYLLIS GENTRY |
| NPI Number: | 1003906157 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 0305 |
| Business Practice Address: | 930 N Flood Ave Norman, OK - 730697642 |
| Business Phone Number: | 4053213719 |
| Business Fax Number: | |
| Mailing Address: | 522 Trinidad Dr, NORMAN |
| State: | OK |
| Postal Code: | 730725109 |
| Phone Number: | 4059282044 |
| Fax Number: | |
| NPI Enumeration Date: | 10/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 0305 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |