Provider Demographics
NPI:1225194186
Name:THE PRICE DECKER CLINIC
Entity Type:Organization
Organization Name:THE PRICE DECKER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LCSW
Authorized Official - Phone:715-362-5437
Mailing Address - Street 1:2905 ROLLINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-9187
Mailing Address - Country:US
Mailing Address - Phone:715-282-6107
Mailing Address - Fax:
Practice Address - Street 1:21 S BROWN ST
Practice Address - Street 2:SUITE B
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3450
Practice Address - Country:US
Practice Address - Phone:715-362-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2780-125101YM0800X
WI3361-125101YM0800X
WI2170-123101YM0800X
WI2124-123101YM0800X
WI35255-020103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32064800Medicaid
WI570412OtherVALUE OPTIONS INSURANCE
WI142406OtherVALUE OPTIONS INSURANCE
WI342442OtherVALUE OPTIONS INSURANCE
WI39283400Medicaid
WI42236600Medicaid
WI561257OtherVALUE OPTIONS INSURANCE
WI348018OtherMHN INSURANCE
WI561255OtherVALUE OPTIONS INSURANCE
WI122790OtherMHN INSURANCE
WI39193600Medicaid
WI39782000Medicaid
WI348019OtherMHN INSURANCE
WI201110OtherMHN INSRUANCE
WI40977100Medicaid