Mr Kenneth Michael Pettis Jr, LMFT in Lodi, CA - Medicare Marriage & Family Therapist Provider

Mr Kenneth Michael Pettis Jr, LMFT is a medicare enrolled "Marriage & Family Therapist" provider in Lodi, California. His current practice location is 315 W Pine St #3, 95240, Lodi, California. You can reach out to his office (for appointments etc.) via phone at (209) 366-2273.

Mr Kenneth Michael Pettis Jr is licensed to practice in California (license number 150072) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1699485540.

Contact Information

	Mr Kenneth Michael Pettis Jr, LMFT
	315 W Pine St #3, 95240, Lodi, CA 95240-4094
	(209) 366-2273
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Mr Kenneth Michael Pettis Jr
Gender	Male
Speciality	Marriage & Family Therapist
Location	315 W Pine St #3, 95240, Lodi, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1699485540
Provider Enumeration Date: 12/01/2022
Last Update Date: 10/15/2024

Medicare PECOS Information:

PECOS PAC ID: 4880122886
Enrollment ID: I20250103001274

Medical Identifiers

Medical identifiers for Mr Kenneth Michael Pettis Jr such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1699485540	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
106H00000X	Marriage & Family Therapist	150072 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Kenneth Michael Pettis Jr allows following entities to bill medicare on his behalf.

Entity Name	An Elegant Sufficiency A Psychological Corporation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1427655810 PECOS PAC ID: 7315359445 Enrollment ID: O20201215001348

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Kenneth Michael Pettis Jr is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mr Kenneth Michael Pettis Jr, LMFT 5250 Claremont Ave Ste 118, Stockton, CA 95207-5700 Ph: (719) 200-2238	Mr Kenneth Michael Pettis Jr, LMFT 315 W Pine St #3, 95240, Lodi, CA 95240-4094 Ph: (209) 366-2273

Reviews and Comments

Marriage & Family Therapist in Lodi, CA

Mr. John Brian Ford, MFTI Couples Therapy Medicare: Medicare Enrolled Practice Location: 12755 N Highway 88, Lodi, CA 95240 Phone: 209-340-5828
Mrs. Kimberly Ann Laskowski, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 404 W Pine St Ste 1, Lodi, CA 95240 Phone: 209-339-1600
Dulce Espinoza, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: Po Box 891, Lodi, CA 95241 Phone: 209-712-9416
Ms. A. Nanette Purdy-diocson, MFTI # 55302 Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 12755 N Highway 88, Lodi, CA 95240 Phone: 209-340-5838
Julie L. Yee, MFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 1930 Tienda Dr, Suite 102, Lodi, CA 95242 Phone: 209-986-3597
La Toya Littesy, AMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 315 W Pine St Ste 3, Lodi, CA 95240 Phone: 209-366-2273
Kari Ann Seaton, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 13520 E Live Oak Rd, Lodi, CA 95240 Phone: 209-331-2182

Mr Kenneth Michael Pettis Jr, LMFT - Medicare Couples Therapy in Lodi, CA