SPECTRUM BEHAVIORAL HEALTH LLC (NPI# 1053718890) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053718890 |
| Entity Type | Organization |
| Organization Name | SPECTRUM BEHAVIORAL HEALTH LLC |
| Practice Address |
1496 Bellevue St Suite 101 Green Bay WI 54311-4205 |
| Practice Telephone | 9207842644 |
| Mailing Telephone | 9207842644 |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2015-06-17 |
| Authorized Official Name | LINDA A CARMODY (CLINIC DIRECTOR) |
| Authorized Official Telephone | 9207842646 |
| Authorized Official Credential | MS, LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
1826-33 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 251S00000X | Community/Behavioral Health | 4151-125 | WI | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 100043151 | 05 |
| Street Address |
1496 BELLEVUE ST SUITE 101 |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54311-4205 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164441580 | Debra L Benishek | Registered Nurse | 1496 Bellevue St, Suite 101, Green Bay, WI 54311-4205 | 2006-07-18 |
| 1184922940 | Allison E Pohlman | Social Worker | 1496 Bellevue St, Suite 101, Green Bay, WI 54311-4205 | 2011-03-03 |
| 1710011010 | Homecare Advantage, Inc. | Home Health | 1496 Bellevue St, Suite 501, Green Bay, WI 54311-4205 | 2007-03-16 |
| 1316011653 | Glenda Ann Mcconnell | Registered Nurse | 1496 Bellevue St, Suite 101, Green Bay, WI 54311-4205 | 2006-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295333847 | Karen Ginnow | Pharmacist | Walmart #1908, 2292 Main St, Green Bay, WI 54311 | 2020-10-15 |
| 1639786551 | Maggie Hall | Dental Hygienist | 2633 Development Dr. Ste 40, Green Bay, WI 54311 | 2020-09-24 |
| 1295370807 | Jennifer Marie Arendt | Technician | 2970 Mossy Oak Cir #39, Green Bay, WI 54311 | 2019-11-07 |
| 1518508803 | Cheryl Ann Johnson | Specialist | 830 Edgewood Dr., Green Bay, WI 54311 | 2019-10-08 |
| 1124670898 | Robert H Wagner Family Dentist S.c. | Dentist | 2830 Curry Court, Suite 1, Green Bay, WI 54311 | 2019-07-12 |
| 1821659624 | The Salvation Army | Counselor | The Salvation Army Ray & Joan Kroc Center, 1315 Lime Kiln Road, Green Bay, WI 54311 | 2019-06-24 |
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1861916769 | Atlas Spinal Care | Chiropractor | 2069 Central Ct, Suite 11, Green Bay, WI 54311 | 2017-08-01 |
| 1851844161 | Green Bay Family Dental LLC | Dentist | 2609 Development Dr., Green Bay, WI 54311 | 2016-08-03 |
| 1710382809 | Betsy Hoida | Pharmacist | 2485 Greenbrier Rd., Green Bay, WI 54311 | 2014-10-31 |
| Find all providers in zip 54311 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043725922 | Healthy Hope Counseling LLC | Community/Behavioral Health | 916 Willard Dr Ste 136, Green Bay, WI 54304-6223 | 2017-12-13 |
| 1801283494 | Abundant Life Counseling & Renewal Center LLC | Community/Behavioral Health | 1221 Bellevue St Ste 113, Green Bay, WI 54302-2155 | 2015-04-21 |
| 1609015569 | Occupational Health Services Inc. | Community/Behavioral Health | 2688 Vissers Ct, Green Bay, WI 54313-5856 | 2009-02-16 |
| 1417107590 | New Hope Counseling Center of Wi, Inc. | Community/Behavioral Health | 3021 Holmgren Way, #203, Green Bay, WI 54304-6302 | 2008-09-24 |
| 1699948471 | Robyn Rickert & Associates, LLC | Community/Behavioral Health | 130 E Walnut St Ste 406, Green Bay, WI 54301-4231 | 2008-04-11 |
| 1093869588 | Innovative Counseling Inc | Community/Behavioral Health | 1499 6th St, Innovative Counseling Inc, Green Bay, WI 54304-2252 | 2007-01-22 |
| 1497818454 | Christian Counseling Ministries, Inc. | Community/Behavioral Health | 2150 Memorial Dr, Suite #213, Green Bay, WI 54303-6335 | 2006-12-19 |
| 1063985620 | Mamma Gese | Community/Behavioral Health | 217 N Madison St Ste 4, Green Bay, WI 54301-5103 | 2019-01-07 |
| 1598117822 | Generations Community Services | Community/Behavioral Health | 217 N Madison St, Suite 5, Green Bay, WI 54301-5103 | 2016-07-11 |
| 1871972349 | Innovative Wisconsin, LLC | Community/Behavioral Health | 445 S Madison St, Green Bay, WI 54301-4101 | 2015-05-29 |
| Find all providers in GREEN BAY | ||||
Please comment or provide details below to improve the information on SPECTRUM BEHAVIORAL HEALTH LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.