Provider Demographics
NPI:1215244314
Name:GENTRY BOSNA, JOY MELODEE (LCSW)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:MELODEE
Last Name:GENTRY BOSNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 W WHISPERING WIND DR
Mailing Address - Street 2:SUITE 274
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-2867
Mailing Address - Country:US
Mailing Address - Phone:623-398-9050
Mailing Address - Fax:
Practice Address - Street 1:2060 W WHISPERING WIND DR
Practice Address - Street 2:SUITE 274
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2867
Practice Address - Country:US
Practice Address - Phone:623-398-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-130441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical