Organization
SPARKS PSYCHIATRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY PAUWELS (OWNER/MANAGER)
(503) 782-5651
Entity
Organization
Contact information
Practice address
1500 NW BETHANY BLVD., SUITE 200, BEAVERTON, OR 97006
(503) 782-5651
Mailing address
7698 SW 143RD ST, PALMETTO BAY, FL 33158-1638
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/14/2025
Last updated
07/02/2025
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