Provider Demographics
NPI:1306403134
Name:SPECTRUM OF POSSIBILITIES, LLC
Entity Type:Organization
Organization Name:SPECTRUM OF POSSIBILITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA, LBA, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOMANGUE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:985-860-3752
Mailing Address - Street 1:108 PICONE RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7051
Mailing Address - Country:US
Mailing Address - Phone:985-860-3752
Mailing Address - Fax:985-209-3051
Practice Address - Street 1:108 PICONE RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-7051
Practice Address - Country:US
Practice Address - Phone:985-860-3752
Practice Address - Fax:985-209-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAL-369OtherSTATE BEHAVIOR ANALYST LICENSE