Antonio Gentry
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Madras, OR
NPI 1366149403 · NPPES record last updated Feb 9, 2023
Key facts
- NPI
- 1366149403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 22-05-10400 (OR)
- Practice address
- 850 SW 4TH St Ste 201
Madras, OR 97741-9629 - Phone
- (541) 475-6575
- Fax
- (541) 475-6196
- NPI assigned
- Feb 9, 2023
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 22-05-10400 | OR | Yes |
Addresses
Primary practice location
850 SW 4TH St Ste 201
Madras, OR 97741-9629
Mailing address
850 SW 4TH St Ste 201
Madras, OR 97741-9629
Phone (541) 475-6575
Other providers in Madras, OR
- Aldo Garcia
- Jimmy Garcia
- Melinda Garcia
- Gary Dehm, DMD
- Leaann Gehrke
- Gerald D Gerke
- Rachel Cara Gill
- Shelly Grantham
- Alexander Grimsley
- Lafaye Elizabeth Grooms
All providers in Madras, OR · Addiction (Substance Use Disorder) Counselor in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.