Healthcare Provider Details

I. General information

NPI: 1861737041
Provider Name (Legal Business Name): DECISIONPOINT BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S BROADWAY SUITE 411A
ROCHESTER MN
55904-6502
US

IV. Provider business mailing address

206 S BROADWAY SUITE 411A
ROCHESTER MN
55904-6502
US

V. Phone/Fax

Practice location:
  • Phone: 507-261-7080
  • Fax: 507-424-4432
Mailing address:
  • Phone: 507-261-7080
  • Fax: 507-424-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLP5520
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP1315
License Number StateMN

VIII. Authorized Official

Name: DR. DONALD EDWARD WILLIAMS
Title or Position: PRINCIPAL/PRESIDENT
Credential: PHD, LP, ABPP
Phone: 507-261-7080