Provider Demographics
NPI:1346020393
Name:INNER SPARK THERAPY PLLC
Entity Type:Organization
Organization Name:INNER SPARK THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:936-261-7908
Mailing Address - Street 1:719 SAWDUST RD STE 104
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2946
Mailing Address - Country:US
Mailing Address - Phone:936-261-7908
Mailing Address - Fax:
Practice Address - Street 1:719 SAWDUST RD STE 104
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2946
Practice Address - Country:US
Practice Address - Phone:936-261-7908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty