Provider Demographics
NPI:1801267695
Name:CHAMPOUX, GRETCHEN L (MDIV, PMC, LMHCA)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:L
Last Name:CHAMPOUX
Suffix:
Gender:F
Credentials:MDIV, PMC, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4205
Mailing Address - Country:US
Mailing Address - Phone:206-905-8574
Mailing Address - Fax:
Practice Address - Street 1:1111 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4205
Practice Address - Country:US
Practice Address - Phone:206-905-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60165356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health