Provider Demographics
NPI:1578854998
Name:INGERSOLL, GRETCHEN ELAINE (MA LMHC)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ELAINE
Last Name:INGERSOLL
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:ELAINE
Other - Last Name:GRAFIOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 S PROCTOR ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2047
Mailing Address - Country:US
Mailing Address - Phone:253-396-5800
Mailing Address - Fax:
Practice Address - Street 1:1112 S 5TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3742
Practice Address - Country:US
Practice Address - Phone:253-403-7933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60039592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health