Provider Demographics
NPI:1609322833
Name:FORREY, GRETCHEN F (MA)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:F
Last Name:FORREY
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:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:PENNGROVE
Mailing Address - State:CA
Mailing Address - Zip Code:94951-0256
Mailing Address - Country:US
Mailing Address - Phone:707-206-1901
Mailing Address - Fax:
Practice Address - Street 1:1360 NORTH MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PENNGROVE
Practice Address - State:CA
Practice Address - Zip Code:94952-0256
Practice Address - Country:US
Practice Address - Phone:707-206-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF93922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health