Provider Demographics
NPI:1487870051
Name:FETTES, DAN
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:FETTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-1112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6727 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:OTTER LAKE
Practice Address - State:MI
Practice Address - Zip Code:48464-9794
Practice Address - Country:US
Practice Address - Phone:810-793-8957
Practice Address - Fax:810-793-2493
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)