Healthcare Provider Details

I. General information

NPI: 1912311093
Provider Name (Legal Business Name): SPECTRUM HEALTHCARE GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 W MINGUS AVE
COTTONWOOD AZ
86326-4006
US

IV. Provider business mailing address

8 E COTTONWOOD ST
COTTONWOOD AZ
86326-6237
US

V. Phone/Fax

Practice location:
  • Phone: 928-634-2236
  • Fax: 928-634-8960
Mailing address:
  • Phone: 928-634-2236
  • Fax: 928-634-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CORINNE BAILEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 928-634-2236