NPIMap

Organization Active NPI

Decoteau Trauma-Informed Care & Practice, PLLC

  • Psychologist
  • Bismarck, ND
National Provider Identifier
1174890016
Registry record updated Nov 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
392 Issued in ND
Legal business name
DECOTEAU TRAUMA-INFORMED CARE & PRACTICE, PLLC
Practice address
515 1/2 E Broadway Ave
Suite. 106
Bismarck, ND 58501-4408
Phone
(701) 751-0443
Fax
(701) 751-1616
NPI assigned
Nov 21, 2011
Last updated
Nov 23, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tami J De Coteau, PHDNPI 1356426993
Title
Owner
Phone
(701) 751-0443

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 392 ND Primary

Addresses

Primary practice location

515 1/2 E Broadway Ave
Suite. 106
Bismarck, ND 58501-4408

Mailing address

515 1/2 E Broadway Ave
Suite. 106
Bismarck, ND 58501-4408
Phone (701) 751-0443

Other identifiers 2

IdentifierTypeStateIssuer
16472OtherNDMEDICAID INDIVIDUAL PROVIDER NUMBER
16471MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180927002926 ND Part B Supplier - Clinic/Group Practice 7911258025 Receives reassigned benefits from 16 practitioners
Practice locations: Bismarck, ND

National Provider Directory

National Provider Directory

Locations

1320 W Century Ave
Bismarck, ND 58503
Phone (701) 751-0443

515 E Broadway Ave
Ste 106
Bismarck, ND 58501
Phone (701) 751-0443

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448236800000",
    "number": "1174890016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 1/2 E BROADWAY AVE",
            "address_2": "SUITE. 106",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014408",
            "telephone_number": "701-751-0443",
            "fax_number": "701-751-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 1/2 E BROADWAY AVE",
            "address_2": "SUITE. 106",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014408",
            "telephone_number": "701-751-0443",
            "fax_number": "701-751-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECOTEAU TRAUMA-INFORMED CARE & PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-21",
        "last_updated": "2015-11-23",
        "status": "A",
        "authorized_official_last_name": "DE COTEAU",
        "authorized_official_first_name": "TAMI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-751-0443",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ND",
            "license": "392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID INDIVIDUAL PROVIDER NUMBER",
            "identifier": "16472",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16471",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.