Provider Demographics
NPI:1154631125
Name:DECKER, THERESA E (LMFT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:E
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 1:224 HUANDAO SOUTH ROAD, UNIT 105A
Mailing Address - Street 2:ZHENGZHUWAN GARDEN
Mailing Address - City:XIAMEN
Mailing Address - State:FUJIAN
Mailing Address - Zip Code:361005
Mailing Address - Country:CN
Mailing Address - Phone:1865-042-6323
Mailing Address - Fax:
Practice Address - Street 1:224 HUANDAO SOUTH ROAD, UNIT 105A
Practice Address - Street 2:ZHENGZHUWAN GARDEN
Practice Address - City:XIAMEN
Practice Address - State:FUJIAN
Practice Address - Zip Code:361005
Practice Address - Country:CN
Practice Address - Phone:1865-042-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000904106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health