Provider Demographics
NPI:1407460454
Name:SPARKS-MENDOZA, TIFFANY JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JEAN
Last Name:SPARKS-MENDOZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 KING AVE.
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212
Mailing Address - Country:US
Mailing Address - Phone:559-992-8800
Mailing Address - Fax:
Practice Address - Street 1:4001 KING AVE.
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212
Practice Address - Country:US
Practice Address - Phone:559-992-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA777261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical