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Hollis K. Hettig

Marriage & Family Therapist

Behavioral Health & Social Service Providers

5212 Katella Ave, Suite 101, Los Alamitos, CA 90720-2828

PECOS Enrollment

This provider is enrolled in PECOS as HOLLIS HETTIG.

Based on the most recent information from CMS, provider Hollis K. Hettig is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1568591055
Provider Type
Individual
Full Name
Hettig, Hollis K.
Credential
M.S., MFT

Gender
Female
Sole Proprietor
Yes
Enumeration Date
3/2/2007
Last Updated
7/8/2007

Contact Information

Practice Location

5212 Katella Ave, Suite 101, Los Alamitos, CA 90720-2828

(714) 334-5949

Unlisted Fax

Mailing Location

5212 Katella Ave, Suite 101, Los Alamitos, CA 90720-2828

(714) 334-5949

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 106H00000X Primary	Description Marriage & Family Therapist Behavioral Health & Social Service Providers	License MFC 43906 California

Hollis K. Hettig

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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