Organization
SPECTRUM VILLAGE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORI KIM LICHTE-BRILL PSY.D. (CHIEF CLINICAL OFFICER)
(602) 910-0526
Entity
Organization
Contact information
Practice address
4150 W PEORIA AVE, STE. 133, PHOENIX, AZ 85029-3900
(602) 910-0526
(602) 346-0117
Mailing address
4150 W PEORIA AVE, STE. 133, PHOENIX, AZ 85029-3900
(602) 910-0526
(602) 346-0117
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
127
AZ
103TC0700X
Clinical Psychologist
Primary
4484
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
462224
AHCCCS
AZ
Enumeration date
04/14/2015
Last updated
04/14/2015
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