Provider Demographics
NPI:1134461288
Name:STOCKMAN, GRETCHEN JUSTINE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:JUSTINE
Last Name:STOCKMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 MERIDIAN E STE 203
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3436
Mailing Address - Country:US
Mailing Address - Phone:253-370-9713
Mailing Address - Fax:360-493-6399
Practice Address - Street 1:12515 MERIDIAN E STE 203
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3436
Practice Address - Country:US
Practice Address - Phone:253-370-9713
Practice Address - Fax:360-493-6399
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60725630106H00000X
WAMG60297545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist