Provider Demographics
NPI:1376279943
Name:SPARKS, ALEXIS ELAYNE (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ELAYNE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:ELAYNE
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2210
Mailing Address - Country:US
Mailing Address - Phone:618-937-6483
Mailing Address - Fax:618-937-1440
Practice Address - Street 1:2311 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62903-5912
Practice Address - Country:US
Practice Address - Phone:618-457-6703
Practice Address - Fax:618-956-9349
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014593101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health