Provider Demographics
NPI:1275966608
Name:BRILL, GRETCHEN LORRAINE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:LORRAINE
Last Name:BRILL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 N COLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7361
Mailing Address - Country:US
Mailing Address - Phone:208-724-6891
Mailing Address - Fax:208-605-7739
Practice Address - Street 1:2308 N COLE RD STE C
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7361
Practice Address - Country:US
Practice Address - Phone:208-577-7135
Practice Address - Fax:208-605-7739
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health