Provider Demographics
NPI:1598907164
Name:DECKER, EDWARD E JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:DECKER
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5272 S LEWIS AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6563
Mailing Address - Country:US
Mailing Address - Phone:918-695-5124
Mailing Address - Fax:918-495-2043
Practice Address - Street 1:5272 S LEWIS AVE STE 112
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6563
Practice Address - Country:US
Practice Address - Phone:918-695-5124
Practice Address - Fax:918-495-2043
Is Sole Proprietor?:No
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1129101YP2500X
OK321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist