# INNER SPARK THERAPY LLC

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

## Provider details

- **NPI number:** 1295519312
- **Authorized official:** CORINA DAUGHERTY CALHOUN LCSW (OWNER, THERAPIST)
- **Authorized official phone:** (971) 266-4355

## Contact information

- **Practice address:** 134 S WASSON ST, COOS BAY, OR 97420-3235
- **Practice address phone:** (971) 266-4355
- **Mailing address:** 1995 NEWMARK AVE \# 1012, COOS BAY, OR 97420-4727

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 08/21/2023
- **Last updated:** 08/21/2023