MEDICARE: SPARK BEHAVIORAL SOLUTIONS & CONSULTING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1922746734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARK BEHAVIORAL SOLUTIONS & CONSULTING SERVICES LLC

Provider Business Mailing Address
First Line	:	2601 LITTLE ELM PKWY STE 1702
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-2503
Country	:	US
Telephone Number	:	469-264-8630
Fax Number	:	469-553-0847

Provider Business Practice Location Address
First Line	:	2601 LITTLE ELM PKWY STE 1702
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-2503
Country	:	US
Telephone Number	:	469-264-8630
Fax Number	:	469-553-0847

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MAIDELINA NAZARIO-ROMERO
Credential	:	M.S., BCBA, LBA.
Telephone Number	:	469-264-8630

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	12/04/2025

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