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MR. KENNETH MICHAEL PETTIS JR. LMFT
NPI 1699485540
Marriage & Family Therapist in Lodi, CA

Active since December 01, 2022PECOS Enrolled
315 W PINE ST #3, 95240, LODI, CA 95240(209) 366-2273 Get Directions Write a Review

NPPES record last updated: October 15, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mr. Kenneth Michael Pettis Jr. Lmft NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. KENNETH MICHAEL PETTIS JR. LMFT (NPI 1699485540) is an individual marriage & family therapist in Lodi, California, licensed in California (150072) and active in the NPI registry since December 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1699485540
Entity TypeIndividualMale
Primary Taxonomy106H00000X
Provider Legal NameMR. KENNETH MICHAEL PETTIS JR.Credential: LMFT
Location Address315 W PINE ST #3, 95240Lodi, CA 95240-4094
Mailing Address5250 Claremont Ave Ste 118Stockton, CA 95207-5700 · (719) 200-2238
Phone(209) 366-2273
Sole ProprietorNo
Enumeration DateDecember 1, 2022
Last NPPES UpdateOctober 15, 2024
NPPES CertifiedOctober 15, 2024
✔ NPI 1699485540 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · 150072
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Kenneth Michael Pettis Jr. Lmft is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Pettis's NPI number?

The NPI number for Kenneth Pettis is 1699485540. It was assigned to this individual provider in the NPPES registry on December 1, 2022.

Where is Kenneth Pettis located?

Kenneth Pettis practices at 315 W Pine St #3, 95240, Lodi, CA 95240. The listed phone number is (209) 366-2273.

What is Kenneth Pettis's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Kenneth Pettis enrolled in Medicare?

Yes. Kenneth Pettis is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kenneth Pettis was last updated on October 15, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.