MEDICARE: ELITE SPECTRUM CARE

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	106S00000X	Behavior Technician	RBT-16-14988	GA
2	251S00000X	Community/Behavioral Health Agency
3	261QM1300X	Multi-Specialty Clinic/Center
4	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1750822318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE SPECTRUM CARE

Provider Business Mailing Address
First Line	:	2368A RICE BLVD # 108
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2652
Country	:	US
Telephone Number	:	713-730-9335
Fax Number	:	713-583-3419

Provider Business Practice Location Address
First Line	:	10830 CRAIGHEAD DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-5804
Country	:	US
Telephone Number	:	713-730-9335
Fax Number	:	713-583-3419

Authorized Official
Title or Position	:	OWNER
Name	:	LAKESHIA WELLS
Credential	:	BCBA, LBA
Telephone Number	:	713-730-9335

Provider Enumeration Date	:	03/16/2017
Last Update Date	:	09/05/2023

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Directions to “ELITE SPECTRUM CARE ” Practice Location

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