Provider Demographics
NPI:1578724472
Name:LEMIRE, VICTORIA ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:LEMIRE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 W HOWARD CITY EDMORE RD
Mailing Address - Street 2:
Mailing Address - City:SIX LAKES
Mailing Address - State:MI
Mailing Address - Zip Code:48886-9728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3705 W HOWARD CITY EDMORE RD
Practice Address - Street 2:
Practice Address - City:SIX LAKES
Practice Address - State:MI
Practice Address - Zip Code:48886-9728
Practice Address - Country:US
Practice Address - Phone:713-503-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001584A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000575211OtherBLUE CROSS BLUE SHIELD
IN100124010Medicaid