Healthcare Provider Details

I. General information

NPI: 1003986530
Provider Name (Legal Business Name): FULL SPECTRUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N POINT ST
SAN FRANCISCO CA
94133-1550
US

IV. Provider business mailing address

100 N POINT ST
SAN FRANCISCO CA
94133-1550
US

V. Phone/Fax

Practice location:
  • Phone: 415-986-4029
  • Fax: 415-986-4015
Mailing address:
  • Phone: 415-986-4029
  • Fax: 415-986-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number401516
License Number StateCA

VIII. Authorized Official

Name: DR. ALEXANDER DUNWODY BINGHAM
Title or Position: DIRECTOR
Credential:
Phone: 415-986-5232