Basic Information
| Provider Information | |||||||||
| NPI: | 1447484910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HETSCHEL | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HETSCHEL | ||||||||
| OtherFirstName: | DEBBIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MFTI | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 655 CAMINO DE LOS MARES | ||||||||
| Address2: | #120 | ||||||||
| City: | SAN CLEMENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926732809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494874015 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 655 CAMINO DE LOS MARES | ||||||||
| Address2: | #120 | ||||||||
| City: | SAN CLEMENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926732809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494871015 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2009 | ||||||||
| LastUpdateDate: | 12/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 64813 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.