Basic Information
| Provider Information | |||||||||
| NPI: | 1578638516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTIE | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3310 BLACK OAK DR | ||||||||
| Address2: | |||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957654640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164353660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1891 E ROSEVILLE PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956617973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167897082 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 36803 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.