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General NPI Number Information
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NPI Number | 1629314992
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Entity Type | Organization
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Legal Business Name | OFFICE OF GRETCHEN FERNANDEZ, LCSW, PC
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 12830 HILLCREST RD # D-111
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City | DALLAS
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State | TX
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Zip | 75230-1527
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Country | US
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Telephone | 972-816-1162
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Fax | 972-364-9095
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Provider Business Mailing Address
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Address Line | 12830 HILLCREST RD # D-111
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City | DALLAS
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State | TX
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Zip | 75230-1527
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Country | US
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Telephone | 972-816-1162
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Fax | 972-364-9095
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Authorized Official
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Title or Position | CLINICIAN/THERAPIST
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Name | MRS. GRETCHEN LOUISE FERNANDEZ
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Credential | LCSW
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Telephone | 972-816-1162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 31767
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License Number State | TX
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