| Spectrum Behavioral Health Llc | |
|
1496 Bellevue St Suite 101 Green Bay WI 54311-4205 | |
| (920) 784-2644 | |
| Not Available |
| Full Name | Spectrum Behavioral Health Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1496 Bellevue St, Green Bay, Wisconsin |
| Authorized Official Name and Position | Linda A Carmody (CLINIC DIRECTOR) |
| Authorized Official Contact | 9207842646 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Behavioral Health Llc 1496 Bellevue St Suite 101 Green Bay WI 54311-4205 Ph: (920) 784-2644 | Spectrum Behavioral Health Llc 1496 Bellevue St Suite 101 Green Bay WI 54311-4205 Ph: (920) 784-2644 |
| NPI Number | 1053718890 |
|---|---|
| Provider Enumeration Date | 11/21/2014 |
| Last Update Date | 06/17/2015 |
| Medicare PECOS PAC ID | 2961713359 |
|---|---|
| Medicare Enrollment ID | O20150626000303 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053718890 | NPI | - | NPPES |
| 100043151 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 4151-125 (Wisconsin) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 1826-33 (Wisconsin) | Secondary |
| Provider Name | Glenda A Mcconnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316011653 PECOS PAC ID: 6800827494 Enrollment ID: I20070313000293 |
| Provider Name | James J Balza |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720242555 PECOS PAC ID: 1658417373 Enrollment ID: I20091012000216 |
| Provider Name | Debra L Benishek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164441580 PECOS PAC ID: 9931247194 Enrollment ID: I20091109000123 |
| Provider Name | Allison E Pohlman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184922940 PECOS PAC ID: 9133340086 Enrollment ID: I20141020000134 |
| Provider Name | Carrie B Ison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083039259 PECOS PAC ID: 3971874751 Enrollment ID: I20170814000622 |
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