Provider Demographics
NPI:1740700038
Name:HETZLER, ARLYSS CLAIRICE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ARLYSS
Middle Name:CLAIRICE
Last Name:HETZLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62306-0485
Mailing Address - Country:US
Mailing Address - Phone:217-257-8262
Mailing Address - Fax:217-666-4131
Practice Address - Street 1:523 S 8TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4907
Practice Address - Country:US
Practice Address - Phone:217-257-8262
Practice Address - Fax:217-666-4131
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0179711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical