Provider Demographics
NPI:1396182838
Name:SPARKMAN BEHAVIORAL HEALTH, P. C.
Entity Type:Organization
Organization Name:SPARKMAN BEHAVIORAL HEALTH, P. C.
Other - Org Name:LORETTA M SPARKMAN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:SPARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:575-626-1493
Mailing Address - Street 1:PO BOX 571
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-0571
Mailing Address - Country:US
Mailing Address - Phone:866-559-8607
Mailing Address - Fax:866-559-8607
Practice Address - Street 1:313 W COUNTRY CLUB RD
Practice Address - Street 2:SUITE 5
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5804
Practice Address - Country:US
Practice Address - Phone:866-559-8607
Practice Address - Fax:866-559-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02005363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========OtherFEIN