Provider Demographics
NPI:1619263860
Name:HETTIG, MICHAEL S (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:HETTIG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 RIVERVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082
Mailing Address - Country:US
Mailing Address - Phone:507-934-8066
Mailing Address - Fax:
Practice Address - Street 1:620 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1566
Practice Address - Country:US
Practice Address - Phone:507-934-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN#2118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist