Provider Demographics
NPI:1922746734
Name:SPARK BEHAVIORAL SOLUTIONS & CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:SPARK BEHAVIORAL SOLUTIONS & CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAIDELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIO-ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-264-8630
Mailing Address - Street 1:2591 DALLAS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8563
Mailing Address - Country:US
Mailing Address - Phone:469-264-8630
Mailing Address - Fax:469-553-0847
Practice Address - Street 1:2591 DALLAS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8563
Practice Address - Country:US
Practice Address - Phone:469-264-8630
Practice Address - Fax:469-553-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty