Provider Demographics
NPI:1356716369
Name:FULL SPECTRUM COUNSELING
Entity type:Organization
Organization Name:FULL SPECTRUM COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:KARUNA
Authorized Official - Last Name:FLUHART-NEGRETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-535-8693
Mailing Address - Street 1:555 SOQUEL AVE
Mailing Address - Street 2:#190
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2336
Mailing Address - Country:US
Mailing Address - Phone:831-535-8693
Mailing Address - Fax:831-338-2831
Practice Address - Street 1:555 SOQUEL AVE
Practice Address - Street 2:#190
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2336
Practice Address - Country:US
Practice Address - Phone:831-535-8693
Practice Address - Fax:831-338-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1071101YP2500X
CA46611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty