Provider Demographics
NPI:1295387355
Name:SPARK BEHAVIORAL HEALTH AND TMS LLC
Entity Type:Organization
Organization Name:SPARK BEHAVIORAL HEALTH AND TMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITNEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PALOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, PMHNP-BC
Authorized Official - Phone:801-900-4670
Mailing Address - Street 1:110 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2631
Mailing Address - Country:US
Mailing Address - Phone:801-900-4670
Mailing Address - Fax:801-996-7123
Practice Address - Street 1:167 N 400 W # A3
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1909
Practice Address - Country:US
Practice Address - Phone:801-900-4670
Practice Address - Fax:801-996-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty