Provider Demographics
NPI:1184732745
Name:DECATUR PSYCHOLOGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:DECATUR PSYCHOLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WENCE
Authorized Official - Suffix:
Authorized Official - Credentials:D MIN LCPC
Authorized Official - Phone:217-872-1700
Mailing Address - Street 1:3040 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1351
Mailing Address - Country:US
Mailing Address - Phone:217-872-1700
Mailing Address - Fax:217-872-1366
Practice Address - Street 1:3040 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1351
Practice Address - Country:US
Practice Address - Phone:217-872-1700
Practice Address - Fax:217-872-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty