Provider Demographics
NPI:1780731745
Name:DECKER, LORAINE KATHERINE (LMFT)
Entity type:Individual
Prefix:MS
First Name:LORAINE
Middle Name:KATHERINE
Last Name:DECKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:KATHERINE
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:158 S ANDERSON ST
Mailing Address - Street 2:PO BOX 158
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3447
Mailing Address - Country:US
Mailing Address - Phone:715-362-6390
Mailing Address - Fax:715-362-6391
Practice Address - Street 1:158 S ANDERSON ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3447
Practice Address - Country:US
Practice Address - Phone:715-362-6390
Practice Address - Fax:715-362-6391
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI600-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43571500Medicaid