Provider Demographics
NPI:1609611326
Name:GENTRY, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:DRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2625 HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9702
Mailing Address - Country:US
Mailing Address - Phone:541-991-3212
Mailing Address - Fax:541-997-9116
Practice Address - Street 1:2625 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9702
Practice Address - Country:US
Practice Address - Phone:541-991-3212
Practice Address - Fax:541-997-9116
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171M00000X
ORTHW000110758175T00000X
OR24-QMHA-R-5374106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORNAOtherHEALTH PARTNERS
ORTBDMedicaid