NPIMap

Organization Active NPI

Soul Spark Counseling, LLC

  • Mental Health Counselor
  • Farmington, AR
National Provider Identifier
1407632334
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SOUL SPARK COUNSELING, LLC
Practice address
128 Southwinds Rd
Farmington, AR 72730-8678
Phone
(479) 222-1156
NPI assigned
Sep 6, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Tessa Renee Vanderhorn, LACNPI 1174309017
Title
Incorporator/Organizer
Phone
(509) 306-1102

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

128 Southwinds Rd
Farmington, AR 72730-8678

Mailing address

PO Box 1121
Prairie Grove, AR 72753-1121
Phone (479) 222-1156

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1407632334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1121",
            "city": "PRAIRIE GROVE",
            "state": "AR",
            "postal_code": "727531121",
            "telephone_number": "479-222-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 SOUTHWINDS RD",
            "city": "FARMINGTON",
            "state": "AR",
            "postal_code": "727308678",
            "telephone_number": "479-222-1156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL SPARK COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-06",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "VANDERHORN",
        "authorized_official_first_name": "TESSA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "INCORPORATOR/ORGANIZER",
        "authorized_official_telephone_number": "509-306-1102",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.