Healthcare Provider Details

I. General information

NPI: 1326702879
Provider Name (Legal Business Name): NEW SPARK COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 PALM BLVD
BROWNSVILLE TX
78520-5431
US

IV. Provider business mailing address

355 PALM BLVD
BROWNSVILLE TX
78520-5431
US

V. Phone/Fax

Practice location:
  • Phone: 956-455-7811
  • Fax:
Mailing address:
  • Phone: 956-410-2802
  • Fax: 866-892-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JUSTIN QUINTANA
Title or Position: LEAD CLINICIAN/PRACTICE OWNER
Credential: LMFT
Phone: 956-410-2802