Provider Demographics
NPI:1659720134
Name:DECESS, REBECCA KAYE (LMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAYE
Last Name:DECESS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 EUGENIA DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-2006
Mailing Address - Country:US
Mailing Address - Phone:517-204-5375
Mailing Address - Fax:
Practice Address - Street 1:3493 WOODS EDGE
Practice Address - Street 2:103
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5911
Practice Address - Country:US
Practice Address - Phone:517-886-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010911191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical