Spectrum Village, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

4484 Issued in AZ

Legal business name

SPECTRUM VILLAGE, PLLC

Practice address

4150 W Peoria Ave
Ste. 133
Phoenix, AZ 85029-3900

Phone

(602) 910-0526

Fax

(602) 346-0117

NPI assigned

Apr 14, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Lori Kim Lichte-Brill, PSY.D.

Title

Chief Clinical Officer

Phone

(602) 910-0526

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1428969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428969600000",
    "number": "1841686078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 W PEORIA AVE",
            "address_2": "STE. 133",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850293900",
            "telephone_number": "602-910-0526",
            "fax_number": "602-346-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 W PEORIA AVE",
            "address_2": "STE. 133",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850293900",
            "telephone_number": "602-910-0526",
            "fax_number": "602-346-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM VILLAGE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-14",
        "last_updated": "2015-04-14",
        "status": "A",
        "authorized_official_last_name": "LICHTE-BRILL",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "602-910-0526",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "AZ",
            "license": "127",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "4484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "462224",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; 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.