Provider Demographics
NPI:1528137684
Name:DEC, GARY R (PSYD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:DEC
Suffix:
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:100 W ROOSEVELT RD
Mailing Address - Street 2:BLDG. B-5, SUITE 103
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 W ROOSEVELT RD
Practice Address - Street 2:BLDG. B-5, SUITE 103
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5260
Practice Address - Country:US
Practice Address - Phone:630-752-9874
Practice Address - Fax:630-752-9875
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL071-003329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical