Provider Demographics
NPI:1841910239
Name:DECKER, GRANVILLE DAVID (LCSW)
Entity type:Individual
Prefix:MR
First Name:GRANVILLE
Middle Name:DAVID
Last Name:DECKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 OXMOOR RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-1314
Mailing Address - Country:US
Mailing Address - Phone:812-568-8465
Mailing Address - Fax:
Practice Address - Street 1:125 S MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1330
Practice Address - Country:US
Practice Address - Phone:606-638-0938
Practice Address - Fax:859-813-5394
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006043A1041C0700X
KY2596291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical