MEDICARE: MS. GRETCHEN GAYLE CRITES LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC0011293	CO

General Provider Information

NPI Number	:	1902201833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRETCHEN GAYLE CRITES LPC

Provider Business Mailing Address
First Line	:	17530 BAR X RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-1500
Country	:	US
Telephone Number	:	719-377-1138
Fax Number	:

Provider Business Practice Location Address
First Line	:	17530 BAR X RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-1500
Country	:	US
Telephone Number	:	719-377-1138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	11/04/2014

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