Basic Information
| Provider Information | |||||||||
| NPI: | 1689097123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETRIE | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36108 VINSON RD | ||||||||
| Address2: | |||||||||
| City: | PEARL RIVER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704525802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852601914 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1258 BROWNSWITCH RD # C-D | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704611605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856610560 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2014 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6716 | LA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.