Provider Demographics
NPI:1407057797
Name:DECREMER, MICHELE R (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:R
Last Name:DECREMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:RANDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2220 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4315
Mailing Address - Country:US
Mailing Address - Phone:901-567-3554
Mailing Address - Fax:901-567-3559
Practice Address - Street 1:1141 E 3900 S
Practice Address - Street 2:A-170
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1215
Practice Address - Country:US
Practice Address - Phone:801-284-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6619555-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical