Provider Demographics
NPI:1528402906
Name:SPURLOCK, MARK (LMFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SPURLOCK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 LAY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-8611
Mailing Address - Country:US
Mailing Address - Phone:256-546-6324
Mailing Address - Fax:
Practice Address - Street 1:3232 LAY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-8611
Practice Address - Country:US
Practice Address - Phone:256-546-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist