Healthcare Provider Details

I. General information

NPI: 1740136126
Provider Name (Legal Business Name): SPARKZ THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7705 SANTO TOMAS CT NW
ALBUQUERQUE NM
87120-3621
US

IV. Provider business mailing address

7705 SANTO TOMAS CT NW
ALBUQUERQUE NM
87120-3621
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-4480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA PARKER-ZILLICH
Title or Position: OWNER
Credential: LCSW
Phone: 505-414-4480