MEDICARE: MEREDITH ANN DECKER PHD, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	11496	NE
2	103T00000X	Psychologist	1012	NE

General Provider Information

NPI Number	:	1063904456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH ANN DECKER PHD, LP

Provider Business Mailing Address
First Line	:	4800 HOSPITAL PKWY
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-6906
Country	:	US
Telephone Number	:	402-228-3436
Fax Number	:	402-228-3436

Provider Business Practice Location Address
First Line	:	1101 N 10TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-2001
Country	:	US
Telephone Number	:	402-228-3436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	07/31/2020

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