Provider Demographics
NPI:1740463058
Name:RAIFF, GRETCHEN WADE (PHD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:WADE
Last Name:RAIFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16990 DALLAS PKWY
Mailing Address - Street 2:SUITE 255
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1926
Mailing Address - Country:US
Mailing Address - Phone:469-682-1675
Mailing Address - Fax:972-407-0213
Practice Address - Street 1:16990 DALLAS PKWY
Practice Address - Street 2:SUITE 255
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1926
Practice Address - Country:US
Practice Address - Phone:469-682-1675
Practice Address - Fax:972-407-0213
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33021103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling