| Sparks Behavioral Services Llc | |
|
3769 Quarton Rd Bloomfield Township MI 48302-4058 | |
| (248) 894-1966 | |
| Not Available |
| Full Name | Sparks Behavioral Services Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 3769 Quarton Rd, Bloomfield Township, Michigan |
| Authorized Official Name and Position | Steven Paul Sparks (OWNER) |
| Authorized Official Contact | 2488941966 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sparks Behavioral Services Llc 3769 Quarton Rd Bloomfield Township MI 48302-4058 Ph: (248) 894-1966 | Sparks Behavioral Services Llc 3769 Quarton Rd Bloomfield Township MI 48302-4058 Ph: (248) 894-1966 |
| NPI Number | 1891221883 |
|---|---|
| Provider Enumeration Date | 05/11/2017 |
| Last Update Date | 08/30/2022 |
| Certification Date | 08/30/2022 |
| Medicare PECOS PAC ID | 7618351149 |
|---|---|
| Medicare Enrollment ID | O20220901002591 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891221883 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| Provider Name | Conny M Raaymakers |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1487864831 PECOS PAC ID: 8729461843 Enrollment ID: I20220822002535 |
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