Provider Demographics
NPI:1295288355
Name:GENTRY, MICHAEL ASHER (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ASHER
Last Name:GENTRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 N 75TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3543
Mailing Address - Country:US
Mailing Address - Phone:480-269-1727
Mailing Address - Fax:
Practice Address - Street 1:7101 E ORANGE BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-7044
Practice Address - Country:US
Practice Address - Phone:832-746-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-156371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical