Provider Demographics
NPI:1932599859
Name:FULL SPECTRUM COMMUNITY OUTREACH
Entity Type:Organization
Organization Name:FULL SPECTRUM COMMUNITY OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONADA
Authorized Official - Middle Name:HINTON
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:225-810-7773
Mailing Address - Street 1:13675 COURSEY BLVD
Mailing Address - Street 2:1832
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1365
Mailing Address - Country:US
Mailing Address - Phone:225-810-7773
Mailing Address - Fax:
Practice Address - Street 1:1520 THOMAS H DELPIT DR
Practice Address - Street 2:139
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-6626
Practice Address - Country:US
Practice Address - Phone:225-810-7773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health