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General NPI Number Information
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NPI Number | 1801529599
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Entity Type | Organization
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Legal Business Name | SPRK PSYCHOLOGICAL SERVICES INCORPORATED
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 324 N LINCOLN ST
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City | BURBANK
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State | CA
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Zip | 91506-2112
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Country | US
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Telephone | 714-552-0371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1182
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City | SAN FERNANDO
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State | CA
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Zip | 91341-1182
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Country | US
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Telephone | 818-612-0591
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD SCOTT STELLA
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Credential | MD
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Telephone | 805-723-2873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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