Provider Demographics
NPI:1235546417
Name:SPECTRUM BEHAVIORAL CONSULTING LLC
Entity Type:Organization
Organization Name:SPECTRUM BEHAVIORAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:FEARN
Authorized Official - Last Name:SHEPSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MA ABA, BCBA,LBA
Authorized Official - Phone:757-535-1723
Mailing Address - Street 1:1109 FERN LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-2547
Mailing Address - Country:US
Mailing Address - Phone:757-535-1723
Mailing Address - Fax:844-719-9024
Practice Address - Street 1:1109 FERN LN
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-2547
Practice Address - Country:US
Practice Address - Phone:757-535-1723
Practice Address - Fax:844-719-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-19
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000061103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty