Provider Demographics
NPI:1093339814
Name:SPECTRUM THERAPEUTIC LEARNING CENTER, LLC
Entity Type:Organization
Organization Name:SPECTRUM THERAPEUTIC LEARNING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HATHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:931-532-0114
Mailing Address - Street 1:905 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2261
Mailing Address - Country:US
Mailing Address - Phone:931-532-0114
Mailing Address - Fax:855-240-2537
Practice Address - Street 1:2270 THORNTON TAYLOR PKWY STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3669
Practice Address - Country:US
Practice Address - Phone:931-532-0114
Practice Address - Fax:855-240-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty