Basic Information
| Provider Information | |||||||||
| NPI: | 1689702706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKAY | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | JOAN | ||||||||
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| Credential: | MS, MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21520 S PIONEER BLVD | ||||||||
| Address2: | |||||||||
| City: | HAWAIIAN GARDENS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628653644 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21520 PIONEER BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | HAWAIIAN GARDENS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907162603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628653644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 43848 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.