Provider Demographics
NPI:1174697437
Name:ESTES, GRETCHEN L (LCMHC)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:ESTES
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:L
Other - Last Name:MIDGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC
Mailing Address - Street 1:1039 ISLINGTON ST STE 13
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4262
Mailing Address - Country:US
Mailing Address - Phone:603-828-6554
Mailing Address - Fax:603-427-8142
Practice Address - Street 1:1039 ISLINGTON ST STE 13
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4262
Practice Address - Country:US
Practice Address - Phone:603-828-6554
Practice Address - Fax:603-427-8142
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH392101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706655Y0NH01OtherBHN
NH99003227Medicaid
NH99003227Medicaid