| Spectrum Therapy, PLLC | |
|
2441 Shooting Star Way Evans CO 80620-9243 | |
| (970) 236-1798 | |
| Not Available |
| Full Name | Spectrum Therapy, PLLC |
|---|---|
| Speciality | Social Worker |
| Location | 2441 Shooting Star Way, Evans, Colorado |
| Authorized Official Name and Position | Kellan Stack (OWNER) |
| Authorized Official Contact | 9706896388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Therapy, PLLC 2441 Shooting Star Way Evans CO 80620-9243 | Spectrum Therapy, PLLC 2441 Shooting Star Way Evans CO 80620-9243 Ph: (970) 236-1798 |
| NPI Number | 1912861642 |
|---|---|
| Provider Enumeration Date | 12/16/2025 |
| Last Update Date | 12/16/2025 |
| Certification Date | 12/16/2025 |
| Medicare PECOS PAC ID | 2264915529 |
|---|---|
| Medicare Enrollment ID | O20260313004213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912861642 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | () | Primary |
| Provider Name | Kellan Jace Stack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114499811 PECOS PAC ID: 3173006434 Enrollment ID: I20260313004222 |
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