Healthcare Provider Details

I. General information

NPI: 1578854998
Provider Name (Legal Business Name): GRETCHEN ELAINE INGERSOLL M.A. LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN ELAINE GRAFIOUS

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S 5TH ST
TACOMA WA
98405-3742
US

IV. Provider business mailing address

1201 S PROCTOR ST
TACOMA WA
98405-2047
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-7933
  • Fax:
Mailing address:
  • Phone: 253-396-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60039592
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: