Healthcare Provider Details

I. General information

NPI: 1558167817
Provider Name (Legal Business Name): SARA MARIE GENTRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 NORRIS CT
BRADY NE
69123-2727
US

IV. Provider business mailing address

225 NORRIS CT
BRADY NE
69123-2727
US

V. Phone/Fax

Practice location:
  • Phone: 308-520-3270
  • Fax:
Mailing address:
  • Phone: 308-520-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2205
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5934
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: