Provider Demographics
NPI:1649935131
Name:SPECTRUM THERAPY LLC
Entity type:Organization
Organization Name:SPECTRUM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-208-3924
Mailing Address - Street 1:12472 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4721
Mailing Address - Country:US
Mailing Address - Phone:805-208-3924
Mailing Address - Fax:
Practice Address - Street 1:200 MARINA DR
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6023
Practice Address - Country:US
Practice Address - Phone:805-208-3924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty