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General NPI Number Information
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NPI Number | 1093339814
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Entity Type | Organization
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Legal Business Name | SPECTRUM THERAPEUTIC LEARNING CENTER, LLC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 2270 THORNTON TAYLOR PKWY STE B
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3669
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Country | US
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Telephone | 931-532-0114
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Fax | 855-240-2537
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Provider Business Mailing Address
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Address Line | 905 DOGWOOD DR
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-2261
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Country | US
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Telephone | 931-532-0114
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Fax | 855-240-2537
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | STEPHANIE ELAINE HATHCOCK
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Credential | BCBA
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Telephone | 931-532-0114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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