# DECOTEAU TRAUMA-INFORMED CARE & PRACTICE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174890016
- **Authorized official:** DR. TAMI J DE COTEAU PHD (OWNER)
- **Authorized official phone:** (701) 751-0443

## Contact information

- **Practice address:** 515 1/2 E BROADWAY AVE, SUITE. 106, BISMARCK, ND 58501-4408
- **Practice address phone:** (701) 751-0443
- **Practice address fax:** (701) 751-1616
- **Mailing address:** 515 1/2 E BROADWAY AVE, SUITE. 106, BISMARCK, ND 58501-4408
- **Mailing address phone:** (701) 751-0443
- **Mailing address fax:** (701) 751-1616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 392 | ND | Yes |

## Other

- **Enumeration date:** 11/21/2011
- **Last updated:** 11/23/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 16471 | — | ND |
| 01 | — | 16472 | MEDICAID INDIVIDUAL PROVIDER NUMBER | ND |