Provider Demographics
NPI:1811378409
Name:ETHEREDGE, GRETCHEN ELIZABETH (MMFT, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:ETHEREDGE
Suffix:
Gender:F
Credentials:MMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 GRIFFITH RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3942
Mailing Address - Country:US
Mailing Address - Phone:325-428-7360
Mailing Address - Fax:
Practice Address - Street 1:318 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5722
Practice Address - Country:US
Practice Address - Phone:325-672-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201462106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist