Provider Demographics
NPI:1346954617
Name:SPERO'S LIGHTHOUSE
Entity Type:Organization
Organization Name:SPERO'S LIGHTHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:HALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-391-1737
Mailing Address - Street 1:102 S TEJON ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2253
Mailing Address - Country:US
Mailing Address - Phone:719-257-3392
Mailing Address - Fax:
Practice Address - Street 1:102 S TEJON ST STE 1100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2253
Practice Address - Country:US
Practice Address - Phone:719-257-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty