Provider Demographics
NPI:1376093690
Name:MANES, GRETCHEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:
Last Name:MANES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12810 HILLCREST RD
Mailing Address - Street 2:B-225
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1525
Mailing Address - Country:US
Mailing Address - Phone:214-505-0745
Mailing Address - Fax:
Practice Address - Street 1:12810 HILLCREST RD
Practice Address - Street 2:B-225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1525
Practice Address - Country:US
Practice Address - Phone:214-505-0745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health