Basic Information
| Provider Information | |||||||||
| NPI: | 1912127226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SQUIRES | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LPCC, LICDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11629 COUNTY RD W | ||||||||
| Address2: | |||||||||
| City: | WAUSEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435679302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193463053 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4841 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194752535 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 011159 | OH | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | C 0008035 | OH | X | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.