Provider Demographics
NPI:1477881159
Name:SPARLIN, BRENT ALLEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:ALLEN
Last Name:SPARLIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 N AVERS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6301
Mailing Address - Country:US
Mailing Address - Phone:773-296-3120
Mailing Address - Fax:773-296-3191
Practice Address - Street 1:938 W NELSON ST
Practice Address - Street 2:BEHAVIORAL HEALTH SERVICES
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6704
Practice Address - Country:US
Practice Address - Phone:773-296-3120
Practice Address - Fax:773-296-3191
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490074941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical