Spectrum House, INC

NPI #1700510393 in Crestview, Florida

Provider Information

NPI Number: 1700510393
Entity Type: Organization
Organization Name: Spectrum House, INC
Subpart: Yes (part of a larger organization)
Parent Organization: SPECTRUM HOUSE, INC
Primary Specialty: Behavior Analyst
Enumeration Date: Jul 11, 2022
Last Updated: Jul 11, 2022

Practice Location

Address: 851 N WILSON ST
City: Crestview
State: Florida
ZIP Code: 32536-2639
Phone: (850) 607-6910

Authorized Official

Name: TYLER RUSSELL STEVERSON
Title: CREDENTIALING MANAGER
Phone: (850) 607-6910

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Analyst	103K00000X	Primary

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