Healthcare Provider Details

I. General information

NPI: 1396093167
Provider Name (Legal Business Name): GRETCHEN WACHS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 05/14/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 CERRILLOS RD
SANTA FE NM
87505-3512
US

IV. Provider business mailing address

P.O.611
TESUQUE NM
87574
US

V. Phone/Fax

Practice location:
  • Phone: 505-490-5653
  • Fax:
Mailing address:
  • Phone: 505-501-0962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0163211
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: