Provider Demographics
NPI:1306020037
Name:DECKER-MILLER, ELIZABETH ANN (LLP, LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:DECKER-MILLER
Suffix:
Gender:F
Credentials:LLP, LPC
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 565
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-0565
Mailing Address - Country:US
Mailing Address - Phone:269-370-3822
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-2408
Practice Address - Country:US
Practice Address - Phone:269-370-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013683103T00000X
MI6401009590101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional