Provider Demographics
NPI:1710144217
Name:HITTLE, GARY (MFT, PND)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:HITTLE
Suffix:
Gender:M
Credentials:MFT, PND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 BALTIMORE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2015
Mailing Address - Country:US
Mailing Address - Phone:619-464-7771
Mailing Address - Fax:619-464-7772
Practice Address - Street 1:5480 BALTIMORE DR STE 202
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2015
Practice Address - Country:US
Practice Address - Phone:619-464-7771
Practice Address - Fax:619-464-7772
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC7065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679655369OtherGROUP NPI