Provider Demographics
NPI:1962676536
Name:COTTRELL, GRETCHEN SUZANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:SUZANNE
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 WORTH CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4401
Mailing Address - Country:US
Mailing Address - Phone:317-473-1695
Mailing Address - Fax:
Practice Address - Street 1:556 WORTH CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4401
Practice Address - Country:US
Practice Address - Phone:317-473-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005543A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000892086OtherANTHEM