Provider Demographics
NPI:1447094719
Name:GRETCHEN GULOTTA, LLC
Entity type:Organization
Organization Name:GRETCHEN GULOTTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GULOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-476-1031
Mailing Address - Street 1:2335 SW BRIGGS RD APT 32
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1159
Mailing Address - Country:US
Mailing Address - Phone:503-476-1031
Mailing Address - Fax:
Practice Address - Street 1:9 MONROE PKWY STE 250
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8866
Practice Address - Country:US
Practice Address - Phone:503-476-1031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty