Provider Demographics
NPI:1376145946
Name:TOTAL SPECTRUM COUNSELING, A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:TOTAL SPECTRUM COUNSELING, A PSYCHOLOGICAL CORPORATION
Other - Org Name:TOTAL SPECTRUM COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVEE SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LSCW
Authorized Official - Phone:424-254-9101
Mailing Address - Street 1:318 E BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2706
Mailing Address - Country:US
Mailing Address - Phone:424-254-9101
Mailing Address - Fax:
Practice Address - Street 1:318 E BRANCH ST
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2706
Practice Address - Country:US
Practice Address - Phone:424-265-8185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255828158Medicaid
CA1265664551Medicaid