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NPI Code Detail

MEDICARE: FULL SPECTRUM ABA OF ALABAMA LLC

MEDICARE: FULL SPECTRUM ABA OF ALABAMA LLC
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
1106E00000XAssistant Behavior Analyst
2106S00000XBehavior Technician
3103K00000XBehavior Analyst

General Provider Information

NPI Number : 1902440761
Entity Type Code : Organization
Provider Name (Legal Business Name) : FULL SPECTRUM ABA OF ALABAMA LLC
Provider Business Mailing Address
First Line : 212 W TROY ST STE B
Second Line :
City : DOTHAN
State : AL
Zip : 36303-4455
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 212 W TROY ST STE B
Second Line :
City : DOTHAN
State : AL
Zip : 36303-4455
Country : US
Telephone Number : 813-926-5454
Fax Number :
Authorized Official
Title or Position : OWNER
Name : COLLIN EDWARD STREETMAN
Credential : BCBA
Telephone Number : 813-926-5454
Provider Enumeration Date : 11/04/2019
Last Update Date : 11/20/2019

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Directions to “FULL SPECTRUM ABA OF ALABAMA LLC ” Practice Location

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