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General NPI Number Information
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NPI Number | 1306670203
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Entity Type | Organization
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Legal Business Name | OCD, ANXIETY, AND TRAUMA PSYCHOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 09/02/2024
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 69 HIGHLAND AVE
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City | BANGOR
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State | ME
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Zip | 04401-4652
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Country | US
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Telephone | 949-689-3229
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Fax |
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Provider Business Mailing Address
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Address Line | 1968 S COAST HWY # 1171
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. NOELLE DECKMAN
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Credential | PHD
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Telephone | 949-689-3229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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