Provider Demographics
NPI:1922497551
Name:DECKER, MICHAELA (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:DECKER
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 1:4667 S LAKESHORE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7293
Mailing Address - Country:US
Mailing Address - Phone:480-746-4894
Mailing Address - Fax:
Practice Address - Street 1:4667 S LAKESHORE DR STE 2
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7293
Practice Address - Country:US
Practice Address - Phone:480-746-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist