Provider Demographics
NPI:1124594437
Name:SPARKS, RACHAEL DEEANN (PLPC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:DEEANN
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 AMANDA DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-1204
Mailing Address - Country:US
Mailing Address - Phone:573-424-0803
Mailing Address - Fax:
Practice Address - Street 1:2024 CHERRY HILL DR # 201C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5921
Practice Address - Country:US
Practice Address - Phone:573-823-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018027688101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor