Healthcare Provider Details

I. General information

NPI: 1275601791
Provider Name (Legal Business Name): GINA L BENTZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E BUCKEYE ST
NORTH VERNON IN
47265-8343
US

IV. Provider business mailing address

720 N MARR RD
COLUMBUS IN
47201-6660
US

V. Phone/Fax

Practice location:
  • Phone: 812-346-4468
  • Fax: 812-378-8367
Mailing address:
  • Phone: 812-314-3400
  • Fax: 812-378-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042412A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: