Provider Demographics
NPI:1851954713
Name:HETTS, MICHAEL ALLEN (SAC-IT, BA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:HETTS
Suffix:
Gender:M
Credentials:SAC-IT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MADISON EAST CTC
Mailing Address - Street 2:5109 WORLD DAIRY DR
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-3807
Mailing Address - Country:US
Mailing Address - Phone:608-242-0220
Mailing Address - Fax:608-223-0687
Practice Address - Street 1:MADISON EAST CTC
Practice Address - Street 2:5109 WORLD DAIRY DR
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-3807
Practice Address - Country:US
Practice Address - Phone:608-242-0220
Practice Address - Fax:608-223-0687
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17413-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)