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General NPI Number Information
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NPI Number | 1356045744
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Entity Type | Individual
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Provider Name | SONYA EVETTE GENTRY
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Gender | Female
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 2504 CAMINO ENTRADA
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City | SANTA FE
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State | NM
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Zip | 87507-4851
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Country | US
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Telephone | 505-471-4985
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 513
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City | GALLUP
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State | NM
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Zip | 87305-0513
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Country | US
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Telephone | 713-870-5966
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SWB-2024-1004
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License Number State | NM
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