# SPARK BEHAVIORAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114763372
- **Authorized official:** MOHAMED A MOHAMED (AUTHORIZED AGENT)
- **Authorized official phone:** (952) 213-9989

## Contact information

- **Practice address:** 12751 COUNTY ROAD 5 STE 109, BURNSVILLE, MN 55337-2275
- **Practice address phone:** (952) 213-9989
- **Mailing address:** 12751 COUNTY ROAD 5 STE 109, BURNSVILLE, MN 55337-2275
- **Mailing address phone:** (952) 213-9989

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 07/06/2024
- **Last updated:** 07/06/2024