| Capture The Sparks, Llc | |
|
1656 Fenton Ave Saint Johns FL 32259-7288 | |
| (904) 466-6996 | |
| Not Available |
| Full Name | Capture The Sparks, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1656 Fenton Ave, Saint Johns, Florida |
| Authorized Official Name and Position | Michael Trebony (CEO) |
| Authorized Official Contact | 9044666996 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Capture The Sparks, Llc 1656 Fenton Ave Saint Johns FL 32259-7288 Ph: (904) 466-6996 | Capture The Sparks, Llc 1656 Fenton Ave Saint Johns FL 32259-7288 Ph: (904) 466-6996 |
| NPI Number | 1427984988 |
|---|---|
| Provider Enumeration Date | 06/22/2026 |
| Last Update Date | 06/22/2026 |
| Certification Date | 06/22/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427984988 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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