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General NPI Number Information
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NPI Number | 1730940941
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Entity Type | Organization
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Legal Business Name | SPARK RELATIONAL COUNSELING, LLC
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 4804 NW BETHANY BLVD, I-2, #424
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City | PORTLAND
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State | OR
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Zip | 97229
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Country | US
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Telephone | 503-850-8484
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Fax |
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Provider Business Mailing Address
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Address Line | 4804 NW BETHANY BLVD, I-2, #424
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City | PORTLAND
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State | OR
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Zip | 97229
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Country | US
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Telephone | 503-850-8484
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | YIDING HAN
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Credential | LMFT
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Telephone | 503-850-8484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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