=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144074949
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECTRUM BEHAVIORAL CONSULTING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2024
-----------------------------------------------------
Last Update Date | 04/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9700 PACIFIC CT
-----------------------------------------------------
City | BURR RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60527-0706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-632-4350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9700 PACIFIC CT
-----------------------------------------------------
City | BURR RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60527-0706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-632-4350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | MOHAMED KAREM ALNATAFGI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-632-4350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------