| Spark Integrative Wellness, Pllc | |
|
2700 S Roan St Ste 300a Johnson City TN 37601-7556 | |
| (423) 722-2422 | |
| (423) 722-2400 |
| Full Name | Spark Integrative Wellness, Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2700 S Roan St Ste 300a, Johnson City, Tennessee |
| Authorized Official Name and Position | Jennifer Judy (PMHNP) |
| Authorized Official Contact | 4234919146 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spark Integrative Wellness, Pllc 2700 S Roan St Ste 300a Johnson City TN 37601-7556 Ph: (423) 722-2422 | Spark Integrative Wellness, Pllc 2700 S Roan St Ste 300a Johnson City TN 37601-7556 Ph: (423) 722-2422 |
| NPI Number | 1053121574 |
|---|---|
| Provider Enumeration Date | 01/08/2025 |
| Last Update Date | 01/08/2025 |
| Certification Date | 01/08/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053121574 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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