MEDICARE: SPES, INC.

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
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1720372303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPES, INC.

Provider Business Mailing Address
First Line	:	1 OAK PLZ STE 308
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-3043
Country	:	US
Telephone Number	:	828-251-9719
Fax Number	:	828-251-9719

Provider Business Practice Location Address
First Line	:	1 OAK PLZ STE 308
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-3043
Country	:	US
Telephone Number	:	828-251-9719
Fax Number	:	828-251-9719

Authorized Official
Title or Position	:	PRESIDENT
Name	:	C.T.B. HARRIS
Credential	:	PH.D.
Telephone Number	:	828-251-9719

Provider Enumeration Date	:	06/01/2011
Last Update Date	:	06/01/2011

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