Provider Demographics
NPI:1629132204
Name:THOMPSON, GRETCHEN EDITH (LMFT)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:EDITH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2405
Mailing Address - Country:US
Mailing Address - Phone:714-969-0949
Mailing Address - Fax:714-969-0958
Practice Address - Street 1:2124 MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2405
Practice Address - Country:US
Practice Address - Phone:714-969-0949
Practice Address - Fax:714-969-0958
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28142106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist