Healthcare Provider Details

I. General information

NPI: 1417257734
Provider Name (Legal Business Name): AUDRA YORK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDRA GENTZ

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 LAKE OTIS PKWY SUITE 101
ANCHORAGE AK
99508-5227
US

IV. Provider business mailing address

4325 LAUREL ST SUITE 230A
ANCHORAGE AK
99508-5364
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-1000
  • Fax:
Mailing address:
  • Phone: 907-952-8532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number815
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: