Provider Demographics
NPI:1487369740
Name:WOOD, GRETCHEN LYN (MA, LMHC, NCC)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:LYN
Last Name:WOOD
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:MS
Other - First Name:GRETCHEN
Other - Middle Name:L
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 E LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3139
Mailing Address - Country:US
Mailing Address - Phone:260-426-3347
Mailing Address - Fax:
Practice Address - Street 1:333 E LEWIS ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3139
Practice Address - Country:US
Practice Address - Phone:260-426-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004999A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health