Provider Demographics
NPI:1174345094
Name:GENTRY, MELISSA (PSYD, CCHT)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:PSYD, CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 WESTWOOD BLVD # 363
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2109
Mailing Address - Country:US
Mailing Address - Phone:310-770-1934
Mailing Address - Fax:
Practice Address - Street 1:315 S BEVERLY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4312
Practice Address - Country:US
Practice Address - Phone:310-770-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94026908103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist