Provider Demographics
NPI:1033398979
Name:MARSH, GRETCHEN MORAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:MORAN
Last Name:MARSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48301-2566
Mailing Address - Country:US
Mailing Address - Phone:248-766-0260
Mailing Address - Fax:
Practice Address - Street 1:26111 W 14 MILE RD STE LL2
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1169
Practice Address - Country:US
Practice Address - Phone:248-766-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical