Provider Demographics
NPI:1699194852
Name:SPECTRUM PSYCHOLOGY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:SPECTRUM PSYCHOLOGY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LAHANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-621-7257
Mailing Address - Street 1:1772 E BOSTON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6243
Mailing Address - Country:US
Mailing Address - Phone:480-621-7257
Mailing Address - Fax:480-584-5825
Practice Address - Street 1:1772 E BOSTON ST
Practice Address - Street 2:BLDG 5 STE 105
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6242
Practice Address - Country:US
Practice Address - Phone:480-427-0303
Practice Address - Fax:480-603-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty