MEDICARE: SPECTRUMEMPOWERED, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1982286159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUMEMPOWERED, LLC

Provider Business Mailing Address
First Line	:	6711 MORNING GLORY TRCE
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2063
Country	:	US
Telephone Number	:	281-788-7387
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 MORNING GLORY TRCE
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2063
Country	:	US
Telephone Number	:	281-788-7387
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHAYQUANA GLOVER
Credential	:
Telephone Number	:	281-788-7387

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	10/11/2022

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