Doctor Name: | BRENN ROBERT GENT |
NPI Number: | 1669510384 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 2007002250 |
Business Practice Address: | 130 Calo Ln Lake Ozark, MO - 650499208 |
Business Phone Number: | 5733652221 |
Business Fax Number: | 5733652224 |
Mailing Address: | 130 Calo Ln, LAKE OZARK |
State: | MO |
Postal Code: | 650499208 |
Phone Number: | 5733652221 |
Fax Number: | 5733652224 |
NPI Enumeration Date: | 02/02/2007 |
NPI Last Update Date: | 09/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2007002250 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |