Provider Demographics
NPI:1609024793
Name:SPARKS, TYLER J (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:J
Last Name:SPARKS
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12166 OLD BIG BEND RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6844
Mailing Address - Country:US
Mailing Address - Phone:314-971-9512
Mailing Address - Fax:888-909-9204
Practice Address - Street 1:12166 OLD BIG BEND RD
Practice Address - Street 2:SUITE 307
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6844
Practice Address - Country:US
Practice Address - Phone:314-971-9512
Practice Address - Fax:888-909-9204
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional