Spectrum Behavioral Services LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

SPECTRUM BEHAVIORAL SERVICES LLC

Practice address

418 E Mishawaka Ave
Mishawaka, IN 46545-6820

Phone

(574) 855-3571

NPI assigned

Jan 8, 2021

Last updated

Jan 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amanda Dorman, BCBANPI 1558725267

Title

Owner

Phone

(574) 855-3571

Specialties & licenses 1

Addresses

Other names 1

• Spectrum Behavioral Services LLC Former legal business name

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amanda Keri Dorman, MA, BCBA

  • Behavior Analyst
  • South Bend, IN
  • NPI 1558725267
  NPD Authorized official
• Ravin Janine Prucey, RBT

  • Behavior Technician
  • Mishawaka, IN
  • NPI 1861376592
  NPD
• Jennifer Hann

  • Behavior Technician
  • Mishawaka, IN
  • NPI 1477484426
  NPD (past)

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

{
    "created_epoch": "1610064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610064000000",
    "number": "1548858160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 E MISHAWAKA AVE",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465456820",
            "telephone_number": "574-855-3571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 E MISHAWAKA AVE",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465456820",
            "telephone_number": "574-855-3571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM BEHAVIORAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-08",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A",
        "authorized_official_last_name": "DORMAN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-855-3571",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spectrum Behavioral Services LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Behavior Analyst in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Behavior Analyst in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.