Provider Demographics
NPI:1972658144
Name:WESLEY SPECTRUM SERVICES
Entity type:Organization
Organization Name:WESLEY SPECTRUM SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:MUETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-831-9390
Mailing Address - Street 1:243 JOHNSTON RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SAINT CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2534
Mailing Address - Country:US
Mailing Address - Phone:412-831-9390
Mailing Address - Fax:412-831-8868
Practice Address - Street 1:5250 CASTE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-1502
Practice Address - Country:US
Practice Address - Phone:412-831-9390
Practice Address - Fax:412-831-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA422720101YM0800X, 101YS0200X, 251300000X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001340160011Medicaid
PA329484A847396OtherVBH OF PA
PA1001340160004Medicaid