Provider Demographics
NPI:1609560242
Name:LINES, GRETCHEN PAYGE (MASTERS INTERN)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:PAYGE
Last Name:LINES
Suffix:
Gender:F
Credentials:MASTERS INTERN
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:PAYGE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1510
Mailing Address - Country:US
Mailing Address - Phone:606-879-6454
Mailing Address - Fax:
Practice Address - Street 1:2118 E SPRAGUE AVE RM 123
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3125
Practice Address - Country:US
Practice Address - Phone:509-838-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61439998101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor