Provider Demographics
NPI:1730747197
Name:GENTRY, ANDY LUTHER (LPC-S; LMFT; LCDC)
Entity type:Individual
Prefix:MR
First Name:ANDY
Middle Name:LUTHER
Last Name:GENTRY
Suffix:
Gender:M
Credentials:LPC-S; LMFT; LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 REEF POINT LN STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-2056
Mailing Address - Country:US
Mailing Address - Phone:682-312-8184
Mailing Address - Fax:
Practice Address - Street 1:6012 REEF POINT LN STE C
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2056
Practice Address - Country:US
Practice Address - Phone:682-312-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1882101YA0400X
TX3472101YP1600X, 101YS0200X
TX1367106H00000X
TX9272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist