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General NPI Number Information
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NPI Number | 1154780047
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Entity Type | Organization
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Legal Business Name | SPECTRUM FAMILY THERAPY
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Dates
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Enumeration Date | 02/19/2016
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Last Update Date | 02/19/2016
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Provider Practice Location Address
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Address Line | 6220 CAMPBELL RD STE 102
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City | DALLAS
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State | TX
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Zip | 75248-1394
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Country | US
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Telephone | 469-209-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 6220 CAMPBELL RD STE 102
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City | DALLAS
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State | TX
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Zip | 75248-1394
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Country | US
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Telephone | 469-209-1111
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Fax |
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Authorized Official
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Title or Position | OPERATIONS ADMINISTRATION
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Name | AMANDA MANDELL
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Credential | B.A.
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Telephone | 214-893-7263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 42032
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License Number State | TX
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