Spark Counseling Center, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SPARK COUNSELING CENTER, LLC

Practice address

3427 Washington Ave
Gulfport, MS 39507-3039

Phone

(504) 300-9811

Fax

(800) 416-3070

NPI assigned

Feb 23, 2019

Last updated

Feb 23, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Dodson, LMFT

Title

Registered Agent/Owner

Phone

(504) 300-9811

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cori L Walker, LCSW

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1851808893

  Mental Health

  NPD (past)

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

{
    "created_epoch": "1550880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550880000000",
    "number": "1942767140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2937",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395052937",
            "telephone_number": "504-300-9811",
            "fax_number": "800-416-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3427 WASHINGTON AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395073039",
            "telephone_number": "504-300-9811",
            "fax_number": "800-416-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-23",
        "last_updated": "2019-02-23",
        "status": "A",
        "authorized_official_last_name": "DODSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "REGISTERED AGENT/OWNER",
        "authorized_official_telephone_number": "504-300-9811",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Prosthetic Care LLC
• Southern Urology Associates LLC (Southern Urology Associates)
• Southern Urology Associates LLC
• Southern Vision Center Gulfport LLC (Southern Vision Center)
• Mae Ditta Spahr IX, CRNA
• Michael Todd Spataro, M.D.
• Kristian Nicole Spear, NP
• Meagan Spear, M.D
• Specialized Speech Therapy
• Specialized Treatment Facility

• Mental Health Counselor in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Mental Health Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2019; 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.