MEDICARE: VIVIAN AUGER GENTZ LCSW, RPT-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	209	OK

General Provider Information

NPI Number	:	1346319894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN AUGER GENTZ LCSW, RPT-S

Provider Business Mailing Address
First Line	:	5509 S LEWIS AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-7104
Country	:	US
Telephone Number	:	918-742-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	5509 S LEWIS AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-7104
Country	:	US
Telephone Number	:	918-742-0700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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