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Organization
DECOTEAU TRAUMA-INFORMED CARE & PRACTICE, PLLC
Active
Organization
DECOTEAU TRAUMA-INFORMED CARE & PRACTICE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAMI J DE COTEAU PHD (OWNER)
(701) 751-0443
Entity
Organization
Contact information
Practice address
515 1/2 E BROADWAY AVE, SUITE. 106, BISMARCK, ND 58501-4408
(701) 751-0443
(701) 751-1616
Mailing address
515 1/2 E BROADWAY AVE, SUITE. 106, BISMARCK, ND 58501-4408
(701) 751-0443
(701) 751-1616
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
392
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16471
—
ND
01
—
16472
MEDICAID INDIVIDUAL PROVIDER NUMBER
ND
Enumeration date
11/21/2011
Last updated
11/23/2015
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