Provider Demographics
NPI:1831650035
Name:SPECTRUS PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:SPECTRUS PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-205-8335
Mailing Address - Street 1:2650 FM 407 E STE 255J
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-7022
Mailing Address - Country:US
Mailing Address - Phone:940-205-8335
Mailing Address - Fax:877-809-9255
Practice Address - Street 1:2650 FM 407 E STE 255J
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:TX
Practice Address - Zip Code:76226-7022
Practice Address - Country:US
Practice Address - Phone:940-205-8335
Practice Address - Fax:877-809-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37608OtherCIGNA