Provider Demographics
NPI:1245404201
Name:HUBBLE, GRETCHEN RENEE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:RENEE
Last Name:HUBBLE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11116 ZEALAND AVE N STE 117
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3594
Mailing Address - Country:US
Mailing Address - Phone:763-746-0844
Mailing Address - Fax:763-746-0843
Practice Address - Street 1:11116 ZEALAND AVE N STE 117
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3594
Practice Address - Country:US
Practice Address - Phone:763-746-0844
Practice Address - Fax:763-746-0843
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health