Provider Demographics
NPI:1598326738
Name:SPECTRUM SOCIAL COMMUNICATION & COUNSELING LLC
Entity Type:Organization
Organization Name:SPECTRUM SOCIAL COMMUNICATION & COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / LMSW
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-505-5043
Mailing Address - Street 1:805 OAKWOOD DR STE 112
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6206
Mailing Address - Country:US
Mailing Address - Phone:248-505-6133
Mailing Address - Fax:
Practice Address - Street 1:805 OAKWOOD DR STE 112
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6206
Practice Address - Country:US
Practice Address - Phone:248-505-6133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty