Healthcare Provider Details

I. General information

NPI: 1144880626
Provider Name (Legal Business Name): ELIAS O DECKER QMHS - BACHELOR'S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MARIE DECKER

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CROSS ST
AKRON OH
44311-1026
US

IV. Provider business mailing address

150 CROSS ST
AKRON OH
44311-1026
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-9388
  • Fax: 330-376-6726
Mailing address:
  • Phone: 330-253-9388
  • Fax: 330-376-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2406291
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: