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General NPI Number Information
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NPI Number | 1629461405
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Entity Type | Organization
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Legal Business Name | SPECTRUM ANALYTIC CONSULTING LLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 750 HAMMOND DR NE BLDG 16 STE 100
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City | ATLANTA
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State | GA
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Zip | 30328-6144
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Country | US
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Telephone | 678-974-2162
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Fax | 888-533-9896
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Provider Business Mailing Address
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Address Line | PO BOX 76094
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City | ATLANTA
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State | GA
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Zip | 30358
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Country | US
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Telephone | 678-974-2162
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Fax | 888-533-9896
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KRISTEN BUSH
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Credential |
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Telephone | 678-974-2162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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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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