Provider Demographics
NPI:1104283654
Name:HERNDON, GRETCHEN ELIZABETH (MA, LPC)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-2901
Mailing Address - Country:US
Mailing Address - Phone:928-524-6126
Mailing Address - Fax:928-524-6090
Practice Address - Street 1:103 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-2901
Practice Address - Country:US
Practice Address - Phone:928-524-6126
Practice Address - Fax:928-524-6090
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional