| Sprk Psychological Services Incorporated | |
|
324 N Lincoln St Burbank CA 91506-2112 | |
| (714) 552-0371 | |
| Not Available |
| Full Name | Sprk Psychological Services Incorporated |
|---|---|
| Speciality | Psychologist |
| Location | 324 N Lincoln St, Burbank, California |
| Authorized Official Name and Position | Edward Scott Stella (OWNER) |
| Authorized Official Contact | 8057232873 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sprk Psychological Services Incorporated Po Box 1182 San Fernando CA 91341-1182 Ph: (818) 612-0591 | Sprk Psychological Services Incorporated 324 N Lincoln St Burbank CA 91506-2112 Ph: (714) 552-0371 |
| NPI Number | 1801529599 |
|---|---|
| Provider Enumeration Date | 07/08/2022 |
| Last Update Date | 08/26/2022 |
| Certification Date | 08/05/2022 |
| Medicare PECOS PAC ID | 2567904725 |
|---|---|
| Medicare Enrollment ID | O20240604001767 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801529599 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Dae Lee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851620439 PECOS PAC ID: 2769523679 Enrollment ID: I20100113000776 |
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