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General NPI Number Information
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NPI Number | 1932485141
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Entity Type | Organization
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Legal Business Name | BRENT DECKER, PH.D., PA
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 11 W 23RD ST SUITE D1
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City | PANAMA CITY
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State | FL
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Zip | 32405-7603
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Country | US
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Telephone | 850-522-9456
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Fax | 850-522-9094
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Provider Business Mailing Address
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Address Line | 11 W 23RD ST SUITE D1
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City | PANAMA CITY
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State | FL
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Zip | 32405-7603
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Country | US
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Telephone | 850-522-9456
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Fax | 850-522-9094
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Authorized Official
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Title or Position | P/V/S/T
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Name | DR. BRENT DECKER
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Credential | PH.D.
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Telephone | 850-522-9456
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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 | PY5989
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License Number State | FL
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