Doctor Name: | GRETCHEN ELIZABETH HERNDON |
NPI Number: | 1104283654 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC |
License Number: | LPC-15938 |
Business Practice Address: | 103 N 1st Ave Holbrook, AZ - 860252901 |
Business Phone Number: | 9285246126 |
Business Fax Number: | 9285246090 |
Mailing Address: | 103 N 1st Ave, HOLBROOK |
State: | AZ |
Postal Code: | 860252901 |
Phone Number: | 9285246126 |
Fax Number: | 9285246090 |
NPI Enumeration Date: | 01/27/2016 |
NPI Last Update Date: | 01/27/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC-15938 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |