Provider Demographics
NPI:1780935148
Name:SPECTRUM COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:SPECTRUM COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, LMHC
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:MARTINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, NCC
Authorized Official - Phone:850-726-0937
Mailing Address - Street 1:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-0748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 E MONTANA AVE
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-1706
Practice Address - Country:US
Practice Address - Phone:850-547-1230
Practice Address - Fax:850-546-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty