SPECTRUM PSYCHOLOGICAL AND NEUROTHERAPY PC (NPI# 1407221716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407221716 |
| Entity Type | Organization |
| Organization Name | SPECTRUM PSYCHOLOGICAL AND NEUROTHERAPY PC |
| Practice Address |
4542 Bonney Rd Ste B Virginia Beach VA 23462 |
| Mailing Address |
4542 Bonney Rd Ste B Virginia Beach VA 23462-3867 |
| Practice Telephone | 7576401882 |
| Practice Fax Number | 7576400253 |
| Mailing Telephone | 7576401882 |
| Mailing Fax Number | 7576400253 |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2019-08-15 |
| Authorized Official Name | CARL RICHARD ELLIS (OWNER/CEO) |
| Authorized Official Telephone | 7576401882 |
| Authorized Official Credential | ED.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| Y | 103T00000X | Psychologist | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4542 Bonney Rd Ste B, Virginia Beach, VA 23462 | 7576401882 | 7576400253 |
| Street Address |
4542 BONNEY RD STE B |
| City | VIRGINIA BEACH |
| State | VA |
| Zip Code | 23462 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740765551 | Kelly Thorne Woods | Counselor | 4542 Bonney Rd Ste B, Virginia Beach, VA 23462-3867 | 2018-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912534082 | Cheyenne James | Counselor | 297 Independence Blvd., Virginia Beach, VA 23462 | 2020-03-26 |
| 1245871011 | Marathon Transportation Services LLC | Non-emergency Medical Transport (VAN) | 4505 Main Street, Apt 259, Virginia Beach, VA 23462 | 2019-10-03 |
| 1003475153 | Keyuri S Shah | Physical Therapist | 5701 Cleveland St, Ste 600, Virginia Beach, VA 23462 | 2019-06-12 |
| 1629561329 | Mary Katherine Pratt | Physician Assistant | 828 Healthy Way Ste 350, Virginia Beach, VA 23462 | 2018-06-07 |
| 1801387808 | Matrixx Healthcare LLC | Respite Care | 405 S Parliament Dr Ste 106, Virginia Beach, VA 23462 | 2018-05-24 |
| 1518471671 | Newtown Chiropractic Center Pllc | Clinic/Center | 5777 Princess Ann Road, Virginia Beach, VA 23462 | 2017-11-28 |
| 1528587995 | Gary Lee Alexander II | Counselor | 870 N Newtown Road, Virginia Beach, VA 23462 | 2017-09-16 |
| 1801328810 | Servitium Med Va, LLC | Durable Medical Equipment & Medical Supplies | 4445 Corporation Lane Suite 291, Virginia Beach, VA 23462 | 2017-03-29 |
| 1215476171 | Johnnie Walter Cox IIi | Emergency Medical Technician, Basic | 5163 Cleveland Street, Virginia Beach, VA 23462 | 2017-02-13 |
| 1225570179 | Holly Balsamo | Occupational Therapy Assistant | 5345 Marian Lane, Virginia Beach, VA 23462 | 2016-11-09 |
| Find all providers in zip 23462 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346759727 | Lori Ann Kroener | Psychologist | 1020 Independence Blvd Ste 204, Virginia Beach, VA 23455-5542 | 2017-09-28 |
| 1720520620 | Renee Brush | Psychologist | 485 S Independence Blvd Ste 104, Virginia Beach, VA 23452 | 2016-11-08 |
| 1043450877 | Carrie Elizabeth Mathews | Psychologist | 2373 Madison Ave, Virginia Beach, VA 23455 | 2009-03-06 |
| 1821215823 | Jan D. Hembree Phd PC | Psychologist | 2940 N Lynnhaven Rd Ste 110, Virginia Beach, VA 23452-6949 | 2007-04-19 |
| 1134283310 | Psychiatric Services, P.C. | Psychologist | 1630 Donna Dr Ste 102, Virginia Beach, VA 23451-6188 | 2006-12-21 |
| 1629171236 | Lynn A Zoll | Psychologist | 303 34th St, Ste 7, Virginia Beach, VA 23451-2855 | 2006-09-07 |
| 1417964701 | Jennifer Sulouff Ripley | Psychologist | 1000 Regent University Dr, Crb 161, Virginia Beach, VA 23464-5037 | 2006-08-01 |
| 1497701213 | Wendy Coffield | Psychologist | 700 Independence Circle, Suite 3d Independence Therapy Center, Virginia Beach, VA 23455 | 2006-05-25 |
| 1700858685 | Deborah Michelle Edwards | Psychologist | 780 Lynnhaven Pkwy, Suite 400 Atlantic Psychiatric Services, Virginia Beach, VA 23452-7332 | 2006-02-03 |
| 1649255969 | Amarjeet Singh Purewal | Psychologist | 1550 Tomcat Blvd, Virginia Beach, VA 23460 | 2005-12-09 |
| Find all providers in VIRGINIA BEACH | ||||
| City | VIRGINIA BEACH |
| Zip Code | 23462 |
Please comment or provide details below to improve the information on SPECTRUM PSYCHOLOGICAL AND NEUROTHERAPY PC.
| 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.