Provider Demographics
NPI:1194570168
Name:GENTRY, LYDIA (LMSW)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 ANTIOCH ROAD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212
Mailing Address - Country:US
Mailing Address - Phone:828-216-5865
Mailing Address - Fax:
Practice Address - Street 1:6155 OAK STREET
Practice Address - Street 2:SUITE B
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113
Practice Address - Country:US
Practice Address - Phone:816-607-3091
Practice Address - Fax:816-494-9152
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240138971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical