Healthcare Provider Details

I. General information

NPI: 1831676998
Provider Name (Legal Business Name): INTO THE SPECTRUM SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 E INDIAN SCHOOL RD STE 21-194
PHOENIX AZ
85018-5390
US

IV. Provider business mailing address

4340 E INDIAN SCHOOL RD STE 21-194
PHOENIX AZ
85018-5390
US

V. Phone/Fax

Practice location:
  • Phone: 602-377-9980
  • Fax:
Mailing address:
  • Phone: 602-377-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY PETERS
Title or Position: CLINICAL DIRECTOR
Credential: MA, BCBA, LBA
Phone: 602-377-9980