Provider Demographics
NPI:1518543958
Name:THE FULL SPECTRUM CHILD
Entity type:Organization
Organization Name:THE FULL SPECTRUM CHILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEWMEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA OT
Authorized Official - Phone:214-673-5740
Mailing Address - Street 1:2260 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1952
Mailing Address - Country:US
Mailing Address - Phone:817-349-9057
Mailing Address - Fax:817-349-9174
Practice Address - Street 1:2260 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1952
Practice Address - Country:US
Practice Address - Phone:817-349-9057
Practice Address - Fax:817-349-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty