Individual ProviderGary HittleMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address5480 Baltimore Dr Ste 202, La Mesa, CA 91942-2015(619) 464-7771PECOS EnrollmentBased on the most recent information from CMS, provider Gary Hittle is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1710144217Provider TypeIndividualFull NameHittle, GaryTitleDr.CredentialMFT, PN.D.GenderMaleSole ProprietorYesEnumeration Date5/21/2008Last Updated5/21/2008Contact InformationPractice LocationPractice Address5480 Baltimore Dr Ste 202, La Mesa, CA 91942-2015Phone(619) 464-7771Fax(619) 464-7772Mailing LocationMailing Address5480 Baltimore Dr Ste 202, La Mesa, CA 91942-2015Phone(619) 464-7771Fax(619) 464-7772Provider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseMFC7065CaliforniaProvider IdentifiersIDDescriptionIssuerID1679655369DescriptionOtherIssuerGROUP NPICalifornia