Provider Demographics
NPI:1841365384
Name:FRITZE, GABRIELLE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:FRITZE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 ADAMS STREET
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110
Mailing Address - Country:US
Mailing Address - Phone:307-885-9883
Mailing Address - Fax:307-885-5206
Practice Address - Street 1:389 ADAMS STREET
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110
Practice Address - Country:US
Practice Address - Phone:307-885-9883
Practice Address - Fax:307-885-5206
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLMFT 137101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99003227Medicaid
NH7706655Y0NH01OtherBHN
NH99003227Medicaid