Provider Demographics
NPI:1376693135
Name:SPARKS, LUANNE (EDD)
Entity Type:Individual
Prefix:DR
First Name:LUANNE
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E INTERSTATE 30 STE M103
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4047
Mailing Address - Country:US
Mailing Address - Phone:972-270-0425
Mailing Address - Fax:972-463-8107
Practice Address - Street 1:310 E INTERSTATE 30 STE M103
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4047
Practice Address - Country:US
Practice Address - Phone:972-270-0425
Practice Address - Fax:972-463-8107
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist