| Decatur Psychological Associates Pc | |
|
3040 N University Ave Suite 2 Decatur IL 62526-1351 | |
| (217) 872-1700 | |
| (217) 872-1366 |
| Full Name | Decatur Psychological Associates Pc |
|---|---|
| Speciality | Counselor |
| Location | 3040 N University Ave, Decatur, Illinois |
| Authorized Official Name and Position | David Ray Wence (PRESIDENT) |
| Authorized Official Contact | 2178721700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Decatur Psychological Associates Pc 3040 N University Ave Suite 2 Decatur IL 62526-1351 Ph: (217) 872-1700 | Decatur Psychological Associates Pc 3040 N University Ave Suite 2 Decatur IL 62526-1351 Ph: (217) 872-1700 |
| NPI Number | 1184732745 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2466452602 |
|---|---|
| Medicare Enrollment ID | O20070111000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184732745 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (Illinois) | Primary |
| 101Y00000X | Counselor | (Illinois) | Secondary |
| Provider Name | Pamela Starr Burkhart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336584838 PECOS PAC ID: 8123318201 Enrollment ID: I20160601002164 |
| Provider Name | Timothy Howard Moore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144494881 PECOS PAC ID: 2961853429 Enrollment ID: I20240109002187 |
| Provider Name | David Ray Wence |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831209758 PECOS PAC ID: 6800896044 Enrollment ID: I20240126000430 |
| Provider Name | Debra G. Charveron |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154549731 PECOS PAC ID: 7911350897 Enrollment ID: I20240126001894 |
| Provider Name | Elizabeth Lynn Featherstone |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225486665 PECOS PAC ID: 0941645915 Enrollment ID: I20240229001359 |
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