Provider Demographics
NPI:1316218688
Name:SPECTRUM PSYCHOLOGIAL SERVICES, P.C.
Entity Type:Organization
Organization Name:SPECTRUM PSYCHOLOGIAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-774-8316
Mailing Address - Street 1:1751 S NAPERVILLE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5896
Mailing Address - Country:US
Mailing Address - Phone:630-774-8316
Mailing Address - Fax:
Practice Address - Street 1:1751 S NAPERVILLE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5896
Practice Address - Country:US
Practice Address - Phone:630-774-8316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005733103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty