Provider Demographics
NPI:1568663748
Name:AEMMER, MICHAEL C (MA, LSW, LMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:AEMMER
Suffix:
Gender:M
Credentials:MA, LSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 W PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-1940
Mailing Address - Country:US
Mailing Address - Phone:574-546-5161
Mailing Address - Fax:574-546-3952
Practice Address - Street 1:1724 W PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1940
Practice Address - Country:US
Practice Address - Phone:574-546-5161
Practice Address - Fax:574-546-3952
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33002132A104100000X
IN35001197A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist