Provider Demographics
NPI:1730168873
Name:DOUTHIT, GRETCHEN SUZANNE (LPC, LPE, ACADC)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:SUZANNE
Last Name:DOUTHIT
Suffix:
Gender:F
Credentials:LPC, LPE, ACADC
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:SUZANNE
Other - Last Name:VAN KLEEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 N HASTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2425
Mailing Address - Country:US
Mailing Address - Phone:479-968-4200
Mailing Address - Fax:
Practice Address - Street 1:103 N HASTINGS AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2425
Practice Address - Country:US
Practice Address - Phone:479-968-4200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA-236101YA0400X
AR90-14E101YM0800X
ARP9510030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional