Provider Demographics
NPI:1629314992
Name:OFFICE OF GRETCHEN FERNANDEZ, LCSW, PC
Entity Type:Organization
Organization Name:OFFICE OF GRETCHEN FERNANDEZ, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:972-816-1162
Mailing Address - Street 1:12830 HILLCREST RD # D-111
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1527
Mailing Address - Country:US
Mailing Address - Phone:972-816-1162
Mailing Address - Fax:972-364-9095
Practice Address - Street 1:12830 HILLCREST RD # D-111
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1527
Practice Address - Country:US
Practice Address - Phone:972-816-1162
Practice Address - Fax:972-364-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty