Healthcare Provider Details

I. General information

NPI: 1578724472
Provider Name (Legal Business Name): VICTORIA ANN LEMIRE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 W HOWARD CITY EDMORE RD
SIX LAKES MI
48886-9728
US

IV. Provider business mailing address

3705 W HOWARD CITY EDMORE RD
SIX LAKES MI
48886-9728
US

V. Phone/Fax

Practice location:
  • Phone: 713-503-4418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001584A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: