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General NPI Number Information
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NPI Number | 1184732745
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Entity Type | Organization
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Legal Business Name | DECATUR PSYCHOLOGICAL ASSOCIATES PC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3040 N UNIVERSITY AVE SUITE 2
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City | DECATUR
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State | IL
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Zip | 62526-1351
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Country | US
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Telephone | 217-872-1700
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Fax | 217-872-1366
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Provider Business Mailing Address
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Address Line | 3040 N UNIVERSITY AVE SUITE 2
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City | DECATUR
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State | IL
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Zip | 62526-1351
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Country | US
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Telephone | 217-872-1700
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Fax | 217-872-1366
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID RAY WENCE
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Credential | D MIN LCPC
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Telephone | 217-872-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | IL
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