Provider Demographics
NPI:1437300902
Name:SPARKS, DEBORAH (LMHC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 W 660 S
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-9249
Mailing Address - Country:US
Mailing Address - Phone:765-538-3207
Mailing Address - Fax:
Practice Address - Street 1:100 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4884
Practice Address - Country:US
Practice Address - Phone:765-447-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001947A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health