Provider Demographics
NPI:1477266492
Name:LIGHT, GRETCHEN ELIZABETH (MA)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:LIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6647 SE MILWAUKIE AVE STE B210
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5661
Mailing Address - Country:US
Mailing Address - Phone:503-432-0216
Mailing Address - Fax:971-200-2719
Practice Address - Street 1:6647 SE MILWAUKIE AVE STE B210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5661
Practice Address - Country:US
Practice Address - Phone:503-432-0216
Practice Address - Fax:971-200-2719
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health