Provider Demographics
NPI:1144844283
Name:GENTRY, KAREN ELAINE (CADTP #9994, MSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ELAINE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:CADTP #9994, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD ST STE 106
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2500
Mailing Address - Country:US
Mailing Address - Phone:916-223-8027
Mailing Address - Fax:
Practice Address - Street 1:12183 LOCKSLEY LN STE 101
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2050
Practice Address - Country:US
Practice Address - Phone:916-223-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA9994101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program