Provider Demographics
NPI:1801655477
Name:GOLDEN SPARK COUNSELING
Entity type:Organization
Organization Name:GOLDEN SPARK COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CMHC
Authorized Official - Phone:385-469-6273
Mailing Address - Street 1:50 W BROADWAY, STE 333
Mailing Address - Street 2:PMB 99540
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101
Mailing Address - Country:US
Mailing Address - Phone:801-999-8670
Mailing Address - Fax:385-900-1700
Practice Address - Street 1:50 W BROADWAY, STE 333
Practice Address - Street 2:PMB 99540
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101
Practice Address - Country:US
Practice Address - Phone:801-999-8670
Practice Address - Fax:385-900-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)