Healthcare Provider Details

I. General information

NPI: 1457097453
Provider Name (Legal Business Name): SPECTRUM CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 W JOHNSTOWN RD STE 115
COLUMBUS OH
43230-2888
US

IV. Provider business mailing address

261 W JOHNSTOWN RD STE 115
COLUMBUS OH
43230-2888
US

V. Phone/Fax

Practice location:
  • Phone: 614-697-3339
  • Fax:
Mailing address:
  • Phone: 614-697-3339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MEGAN IFFLAND
Title or Position: NP
Credential:
Phone: 614-697-3339