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General NPI Number Information
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NPI Number | 1346954617
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Entity Type | Organization
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Legal Business Name | SPERO'S LIGHTHOUSE
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 102 S TEJON ST STE 1100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-2253
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Country | US
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Telephone | 719-257-3392
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Fax |
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Provider Business Mailing Address
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Address Line | 102 S TEJON ST STE 1100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-2253
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Country | US
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Telephone | 719-257-3392
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | HALEE FULLERTON
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Credential |
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Telephone | 620-391-1737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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