Provider Demographics
NPI:1487671996
Name:DIDIER, MICHAEL J (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DIDIER
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-1218
Mailing Address - Country:US
Mailing Address - Phone:260-456-4880
Mailing Address - Fax:260-456-3559
Practice Address - Street 1:2805 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-1218
Practice Address - Country:US
Practice Address - Phone:260-456-4880
Practice Address - Fax:260-486-3559
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000820A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist