Healthcare Provider Details

I. General information

NPI: 1205742855
Provider Name (Legal Business Name): SPARK BIRD THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 BALTIMORE AVE
PHILADELPHIA PA
19143-3503
US

IV. Provider business mailing address

5219 WEBSTER ST
PHILADELPHIA PA
19143-2626
US

V. Phone/Fax

Practice location:
  • Phone: 917-250-1688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: EMILY ENDRES
Title or Position: CO-OWNER
Credential: LPC
Phone: 267-225-3559