Organization
SPARK BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMED A MOHAMED (AUTHORIZED AGENT)
(952) 213-9989
Entity
Organization
Contact information
Practice address
12751 COUNTY ROAD 5 STE 109, BURNSVILLE, MN 55337-2275
(952) 213-9989
Mailing address
12751 COUNTY ROAD 5 STE 109, BURNSVILLE, MN 55337-2275
(952) 213-9989
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
07/06/2024
Last updated
07/06/2024
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