NPIMap

Organization Active NPI

Spectrum Psychology and Wellness, LLC

  • Clinical Psychologist
  • Gilbert, AZ
National Provider Identifier
1699194852
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SPECTRUM PSYCHOLOGY AND WELLNESS, LLC
Practice address
1772 E Boston St
BLDG 5 Ste 105
Gilbert, AZ 85295-6242
Phone
(480) 427-0303
Fax
(480) 603-3914
NPI assigned
Apr 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Authorized official

Name
Mr. Jeff Lahann
Title
Manager
Phone
(480) 621-7257

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X AZ Primary

Addresses

Primary practice location

1772 E Boston St
BLDG 5 Ste 105
Gilbert, AZ 85295-6242

Mailing address

1772 E Boston St Ste 105
Gilbert, AZ 85295-6243
Phone (480) 621-7257

Other practice location 1

6640 E Baseline Rd Ste 102
Mesa, AZ 85206-4437
Phone (480) 621-7257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140523000689 AZ Part B Supplier - Clinic/Group Practice 4981827763 Receives reassigned benefits from 7 practitioners
Practice locations: Gilbert, AZ; Mesa, AZ

National Provider Directory

National Provider Directory
Tax ID family
Spectrum Psychology and Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1772 E Boston St
Ste 105
Gilbert, AZ 85295
Phone (480) 621-7257

6640 E Baseline Rd
Ste 102
Mesa, AZ 85206
Phone (480) 621-7257

18521 E Queen Creek Rd
#105414
Queen Creek, AZ 85142

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698969600000",
    "number": "1699194852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1772 E BOSTON ST STE 105",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852956243",
            "telephone_number": "480-621-7257",
            "fax_number": "480-584-5825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1772 E BOSTON ST",
            "address_2": "BLDG 5 STE 105",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852956242",
            "telephone_number": "480-427-0303",
            "fax_number": "480-603-3914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6640 E Baseline Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852064437",
            "country_code": "US",
            "telephone_number": "480-621-7257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECTRUM PSYCHOLOGY AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-15",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A",
        "authorized_official_last_name": "LAHANN",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "480-621-7257",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.