Provider Demographics
NPI:1730776477
Name:SPARKS PSYCHIATRY, LLC
Entity type:Organization
Organization Name:SPARKS PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUWATOYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:480-388-2400
Mailing Address - Street 1:9898 BISSONNET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8025
Mailing Address - Country:US
Mailing Address - Phone:713-227-7275
Mailing Address - Fax:
Practice Address - Street 1:15331 W BELL RD STE 212
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4104
Practice Address - Country:US
Practice Address - Phone:480-388-2400
Practice Address - Fax:346-250-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty