Healthcare Provider Details

I. General information

NPI: 1982418257
Provider Name (Legal Business Name): FULL SPECTRUM PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 E ANDERSON ST
IDAHO FALLS ID
83401-2020
US

IV. Provider business mailing address

675 E ANDERSON ST
IDAHO FALLS ID
83401-2020
US

V. Phone/Fax

Practice location:
  • Phone: 208-419-9238
  • Fax: 208-598-7998
Mailing address:
  • Phone: 208-432-1976
  • Fax: 208-278-7956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON A HARRIS
Title or Position: OWNER-PSYCHOLOGIST
Credential: PHD
Phone: 208-419-9238