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NPI Code Detail

MEDICARE: THE FULL SPECTRUM CHILD

MEDICARE: THE FULL SPECTRUM CHILD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1518543958
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE FULL SPECTRUM CHILD
Provider Business Mailing Address
First Line : 2260 COLLEGE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1952
Country : US
Telephone Number : 817-349-9057
Fax Number : 817-349-9174
Provider Business Practice Location Address
First Line : 2260 COLLEGE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1952
Country : US
Telephone Number : 817-349-9057
Fax Number : 817-349-9174
Authorized Official
Title or Position : MEMBER
Name : LAURA TEWMEY
Credential : BCBA OT
Telephone Number : 214-673-5740
Provider Enumeration Date : 03/23/2021
Last Update Date : 01/24/2022

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Directions to “THE FULL SPECTRUM CHILD ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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