Organization
SPECTRUM BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA A CARMODY MS, LPC (CLINIC DIRECTOR)
(920) 784-2646
Entity
Organization
Contact information
Practice address
1496 BELLEVUE ST, SUITE 101, GREEN BAY, WI 54311-4205
(920) 784-2644
Mailing address
1496 BELLEVUE ST, SUITE 101, GREEN BAY, WI 54311-4205
(920) 784-2644
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
4151-125
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
1826-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100043151
—
WI
Enumeration date
11/21/2014
Last updated
06/17/2015
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