Doctor Name: | GRETCHEN KAFKA |
NPI Number: | 1194167544 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 4473 |
Business Practice Address: | 141 Citation Way Unit 5 Hailey, ID - 833335103 |
Business Phone Number: | 2085782222 |
Business Fax Number: | |
Mailing Address: | 141 Citation Way, Unit 5 HAILEY |
State: | ID |
Postal Code: | 833335103 |
Phone Number: | 2085782222 |
Fax Number: | |
NPI Enumeration Date: | 07/26/2013 |
NPI Last Update Date: | 07/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 4473 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |