1396183000 NPI number — SPARKMAN COUNSELING SERVICES LLC

Table of content: JACK L. BERG MD (NPI 1639160021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396183000 NPI number — SPARKMAN COUNSELING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPARKMAN COUNSELING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1396183000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48854-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-676-9788
Provider Business Mailing Address Fax Number:
517-676-3438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2483 S LINDEN RD STE 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-5477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-202-1633
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SPARKMAN
Authorized Official First Name:
VIRGINIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
810-610-1663

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6801088401 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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