Provider Demographics
NPI:1629839329
Name:SPARKMAN, BETHANY CAROL (LPC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:CAROL
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 GRANBY RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37665-1712
Mailing Address - Country:US
Mailing Address - Phone:423-444-9603
Mailing Address - Fax:
Practice Address - Street 1:900 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6720
Practice Address - Country:US
Practice Address - Phone:423-461-7750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6918101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional