Provider Demographics
NPI:1982418257
Name:FULL SPECTRUM PSYCHOLOGY LLC
Entity type:Organization
Organization Name:FULL SPECTRUM PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-419-9238
Mailing Address - Street 1:5272 LONG COVE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8288
Mailing Address - Country:US
Mailing Address - Phone:208-419-9238
Mailing Address - Fax:208-598-7998
Practice Address - Street 1:675 E ANDERSON ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-2020
Practice Address - Country:US
Practice Address - Phone:208-419-9238
Practice Address - Fax:208-598-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty