Healthcare Provider Details

I. General information

NPI: 1326807942
Provider Name (Legal Business Name): SPARKLING PATH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 BOND ST
BROCKWAY PA
15824-1705
US

IV. Provider business mailing address

3487 KEARNEY RD
BROCKWAY PA
15824-1063
US

V. Phone/Fax

Practice location:
  • Phone: 814-503-0453
  • Fax: 814-273-4037
Mailing address:
  • Phone: 814-503-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOAN ELIZABETH CRAWFORD
Title or Position: COUNSELOR/MENTAL HEALTH THERAPIST
Credential: LPC
Phone: 814-503-0453