Active NPI
Jeri Gentry
- Clinical Psychologist
- Goodyear, AZ
National Provider Identifier
1134470271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY-005288
- Practice address
- 2620 N 140TH Ave
Goodyear, AZ 85395-2437 - Phone
- (623) 536-7956
- NPI assigned
- Sep 28, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | PSY-005288 | AZ | |
| Forensic Psychologist | 103TF0200X | PSY-005288 | AZ | |
| Group Psychotherapy Psychologist | 103TP2701X | PSY-005288 | AZ | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | PSY-005288 | AZ | Primary |
Addresses
Primary practice location
2620 N 140TH Ave
Goodyear, AZ 85395-2437
Mailing address
2620 N 140TH Ave Ste 101
Goodyear, AZ 85395-2437
Phone (623) 536-7956
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-005288 | AZ | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Az Center for Change | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Phoenix, AZ
- NPI 1609105642
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647475200000",
"number": "1134470271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2620 N 140TH AVE STE 101",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853952437",
"telephone_number": "623-536-7956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2620 N 140TH AVE",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853952437",
"telephone_number": "623-536-7956"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTRY",
"first_name": "JERI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-28",
"last_updated": "2022-03-17",
"certification_date": "2022-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "AZ",
"license": "PSY-005288",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "AZ",
"license": "PSY-005288",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "AZ",
"license": "PSY-005288",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "PSY-005288",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.