MEDICARE: SPECTRUM BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1826-33	WI
2	251S00000X	Community/Behavioral Health Agency	4151-125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053718890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1496 BELLEVUE ST
Second Line	:	SUITE 101
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4205
Country	:	US
Telephone Number	:	920-784-2644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1496 BELLEVUE ST
Second Line	:	SUITE 101
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4205
Country	:	US
Telephone Number	:	920-784-2644
Fax Number	:

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	LINDA A CARMODY
Credential	:	MS, LPC
Telephone Number	:	920-784-2646

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	06/17/2015

Similar Medicare Providers

1164441580 — DEBRA L BENISHEK APNP
Practice Location Address:

1496 BELLEVUE ST , SUITE 101
GREEN BAY, WI
54311-4205

Practice Phone: 920-784-2644
Practice Fax: 920-784-2655

1710011010 — HOMECARE ADVANTAGE, INC.
Practice Location Address:

1496 BELLEVUE ST , SUITE 501
GREEN BAY, WI
54311-4205

Practice Phone: 920-437-0496
Practice Fax: 920-437-8206

1720264195 — LINDA A CARMODY, MS, LPC
Practice Location Address:

1496 BELLEVUE ST STE 101
GREEN BAY, WI
54311-4205

Practice Phone: 920-784-2644
Practice Fax: 920-784-2655

1184922940 — ALLISON E POHLMAN LCSW
Practice Location Address:

1496 BELLEVUE ST , SUITE 101
GREEN BAY, WI
54311-4205

Practice Phone: 920-784-2644
Practice Fax: 920-784-2655

1427507508 — CAITLIN M CARMODY MS
Practice Location Address:

1496 BELLEVUE ST STE 101
GREEN BAY, WI
54311-4205

Practice Phone: 920-784-2644
Practice Fax: 920-784-2655

1154859619 — BRITTANY ANN BERKOVITZ MED, LPC
Practice Location Address:

1496 BELLEVUE ST STE 502
GREEN BAY, WI
54311-4205

Practice Phone: 920-264-0996
Practice Fax:

Directions to “SPECTRUM BEHAVIORAL HEALTH LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.