Spectra Mental Healthcare, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SPECTRA MENTAL HEALTHCARE, PLLC

Practice address

214 Breckenridge LN
104
Louisville, KY 40207-3868

Phone

(502) 893-3388

NPI assigned

Jan 13, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Karl Bates

Title

Owner

Phone

(502) 893-3388

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1275684698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 BRECKENRIDGE LN",
            "address_2": "104",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402073868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 BRECKENRIDGE LN",
            "address_2": "104",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402073868",
            "telephone_number": "502-893-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRA MENTAL HEALTHCARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-13",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "BATES",
        "authorized_official_first_name": "KARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-893-3388"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS & BLUE SHIELD",
            "identifier": "000000344330",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8290021800",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.