Provider Demographics
NPI:1467426684
Name:SPARKMAN, SHAUN TARA (LMHC NCC RN)
Entity Type:Individual
Prefix:MRS
First Name:SHAUN
Middle Name:TARA
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:LMHC NCC RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2882 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-457-5414
Mailing Address - Fax:360-457-9505
Practice Address - Street 1:2882 MONROE RD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362
Practice Address - Country:US
Practice Address - Phone:360-457-5414
Practice Address - Fax:360-457-9505
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health