| Spark Counseling Llc | |
|
6303 4th St Nw Ste 1 Los Ranchos NM 87107-5855 | |
| (505) 234-6166 | |
| Not Available |
| Full Name | Spark Counseling Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 6303 4th St Nw Ste 1, Los Ranchos, New Mexico |
| Authorized Official Name and Position | Marisa Mancini Rothrock (BUSINESS OWNER) |
| Authorized Official Contact | 5053210906 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spark Counseling Llc 1814 Don Felipe Rd Sw Albuquerque NM 87105-6654 Ph: (505) 321-0906 | Spark Counseling Llc 6303 4th St Nw Ste 1 Los Ranchos NM 87107-5855 Ph: (505) 234-6166 |
| NPI Number | 1508582586 |
|---|---|
| Provider Enumeration Date | 10/12/2022 |
| Last Update Date | 10/12/2022 |
| Certification Date | 10/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508582586 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
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