Provider Demographics
NPI:1568008001
Name:FULL SPECTRUM THERAPY LLC
Entity Type:Organization
Organization Name:FULL SPECTRUM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SKYE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-765-5733
Mailing Address - Street 1:1219 SE LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3802
Mailing Address - Country:US
Mailing Address - Phone:503-765-5733
Mailing Address - Fax:971-244-8583
Practice Address - Street 1:1219 SE LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3802
Practice Address - Country:US
Practice Address - Phone:503-765-5733
Practice Address - Fax:971-244-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty