Provider Demographics
NPI:1508230707
Name:SPECTRUMS FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:SPECTRUMS FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MACI
Authorized Official - Middle Name:N
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-567-1820
Mailing Address - Street 1:8196 SW HALL BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6409
Mailing Address - Country:US
Mailing Address - Phone:503-567-1820
Mailing Address - Fax:971-228-2405
Practice Address - Street 1:8196 SW HALL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6409
Practice Address - Country:US
Practice Address - Phone:503-567-1820
Practice Address - Fax:971-228-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X
OR57641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500652588Medicaid