Provider Demographics
NPI:1972230209
Name:SPECTRUM BEHAVIORAL SERVICES PLLC
Entity Type:Organization
Organization Name:SPECTRUM BEHAVIORAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GELDERLOOS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:406-876-4772
Mailing Address - Street 1:118 N F ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2727
Mailing Address - Country:US
Mailing Address - Phone:406-876-4772
Mailing Address - Fax:
Practice Address - Street 1:118 N F ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2727
Practice Address - Country:US
Practice Address - Phone:406-876-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty