# FULL SPECTRUM THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790668069
- **Authorized official:** DR. JENN GALLUP PH.D. (PSYCHOLOGIST)
- **Authorized official phone:** (208) 406-2492

## Contact information

- **Practice address:** 805 N ARTHUR AVE, POCATELLO, ID 83204-2803
- **Practice address phone:** (208) 274-5925
- **Mailing address:** 805 N ARTHUR AVE, POCATELLO, ID 83204-2803
- **Mailing address phone:** (208) 274-5925

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |
| 103TP2701X | Group Psychotherapy Psychologist | — | NULL | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | — | — |

## Other

- **Enumeration date:** 07/25/2025
- **Last updated:** 07/25/2025