Provider Demographics
NPI:1104326289
Name:SPECTRUM BEHAVIORAL THERAPY CENTER, INC.
Entity type:Organization
Organization Name:SPECTRUM BEHAVIORAL THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KHACHIK
Authorized Official - Last Name:BGDOIAN
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ, BCBA
Authorized Official - Phone:818-452-3577
Mailing Address - Street 1:5355 CARTWRIGHT AVE UNIT 207
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-5490
Mailing Address - Country:US
Mailing Address - Phone:818-456-3309
Mailing Address - Fax:818-452-4740
Practice Address - Street 1:5355 CARTWRIGHT AVE UNIT 207
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-5490
Practice Address - Country:US
Practice Address - Phone:818-456-3309
Practice Address - Fax:818-452-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child