NPIMap

Organization Active NPI

Spectrum House, Inc

  • Behavior Analyst
  • Crestview, FL
National Provider Identifier
1700510393
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
SPECTRUM HOUSE, INC
Practice address
851 N Wilson St
Crestview, FL 32536-2639
Phone
(850) 607-6910
NPI assigned
Jul 11, 2022
Last updated
Jul 11, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SPECTRUM HOUSE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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

Authorized official

Name
Tyler Russell SteversonNPI 1043727555
Title
Credentialing Manager
Phone
(850) 607-6910

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

851 N Wilson St
Crestview, FL 32536-2639

Mailing address

9900 N Davis Hwy
Pensacola, FL 32514-8124
Phone (850) 607-6910

National Provider Directory

National Provider Directory
Tax ID family
Spectrum House Inc8 organizations share this tax ID, including this one
Part of
Spectrum House Inc

Other organizations with this tax ID 7

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

Locations

851 N Wilson St
Crestview, FL 32536
Phone (850) 398-6021

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1700510393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325148124",
            "telephone_number": "850-607-6910",
            "fax_number": "850-607-6932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 N WILSON ST",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325362639",
            "telephone_number": "850-607-6910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HOUSE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECTRUM HOUSE, INC",
        "enumeration_date": "2022-07-11",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "STEVERSON",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "850-607-6910"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; 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.