Spark Counseling LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SPARK COUNSELING LLC

Doing business as

Spark Counseling LLC

Practice address

6303 4TH St NW Ste 1
Los Ranchos, NM 87107-5855

Phone

(505) 234-6166

NPI assigned

Oct 12, 2022

Organization subpart

No

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

Authorized official

Name

Marisa Mancini Rothrock, LPCCNPI 1174024988

Title

Business Owner

Phone

(505) 321-0906

Specialties & licenses 2

Addresses

Other names 1

• Spark Counseling LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Practitioners 1

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

• Marisa Mancini Rothrock

  • Professional Counselor
  • Albuquerque, NM
  • NPI 1174024988

  Mental Health

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1508582586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 DON FELIPE RD SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871056654",
            "telephone_number": "505-321-0906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6303 4TH ST NW STE 1",
            "city": "LOS RANCHOS",
            "state": "NM",
            "postal_code": "871075855",
            "telephone_number": "505-234-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "ROTHROCK",
        "authorized_official_first_name": "MARISA",
        "authorized_official_middle_name": "MANCINI",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "505-321-0906",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spark Counseling LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ann Kimball Spencer, LMSW
• Jolene Spencer
• Aria Sutton, LCSW
• Sylma Fine

• Mental Health Counselor in Los Ranchos, NM
• Providers in Los Ranchos, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.