| Spectrum Psychological And Neurotherapy Pc | |
|
4542 Bonney Rd Ste B Virginia Beach VA 23462 | |
| (757) 640-1882 | |
| (757) 640-0253 |
| Full Name | Spectrum Psychological And Neurotherapy Pc |
|---|---|
| Speciality | Psychologist |
| Location | 4542 Bonney Rd Ste B, Virginia Beach, Virginia |
| Authorized Official Name and Position | Carl Richard Ellis (OWNER/CEO) |
| Authorized Official Contact | 7576401882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Psychological And Neurotherapy Pc 4542 Bonney Rd Ste B Virginia Beach VA 23462-3867 Ph: (757) 640-1882 | Spectrum Psychological And Neurotherapy Pc 4542 Bonney Rd Ste B Virginia Beach VA 23462 Ph: (757) 640-1882 |
| NPI Number | 1407221716 |
|---|---|
| Provider Enumeration Date | 12/11/2015 |
| Last Update Date | 08/15/2019 |
| Medicare PECOS PAC ID | 4385934843 |
|---|---|
| Medicare Enrollment ID | O20160613000866 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407221716 | NPI | - | NPPES |
| Provider Name | Lee Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831308964 PECOS PAC ID: 2163505272 Enrollment ID: I20080215000591 |
| Provider Name | Carl R Ellis |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1821173519 PECOS PAC ID: 4587987169 Enrollment ID: I20150107000675 |
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