| Spark Behavioral Health LLC | |
|
11000 Sw Barbur Blvd Ste 100 Portland OR 97219-8691 | |
| (971) 228-9848 | |
| Not Available |
| Full Name | Spark Behavioral Health LLC |
|---|---|
| Speciality | Clinic/center |
| Location | 11000 Sw Barbur Blvd Ste 100, Portland, Oregon |
| Authorized Official Name and Position | Timnit Yikealo (CO-CEO) |
| Authorized Official Contact | 9712289848 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spark Behavioral Health LLC 4550 Sw Betts Ave # 44 Beaverton OR 97005-2869 | Spark Behavioral Health LLC 11000 Sw Barbur Blvd Ste 100 Portland OR 97219-8691 Ph: (971) 228-9848 |
| NPI Number | 1376359695 |
|---|---|
| Provider Enumeration Date | 12/10/2024 |
| Last Update Date | 06/11/2026 |
| Certification Date | 06/11/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376359695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
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