MEDICARE: TINA M GENTSCH LPC

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	101YM0800X	Mental Health Counselor	61724	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588797591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA M GENTSCH LPC

Provider Business Mailing Address
First Line	:	5934 S STAPLES ST STE 230
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-3800
Country	:	US
Telephone Number	:	361-985-1541
Fax Number	:	361-985-0001

Provider Business Practice Location Address
First Line	:	5934 S STAPLES ST STE 230
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-3800
Country	:	US
Telephone Number	:	361-985-1541
Fax Number	:	361-985-0001

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/19/2010

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Directions to “ TINA M GENTSCH LPC” Practice Location

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