Provider Demographics
NPI:1710217013
Name:SPARKS, STEVEN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:SPARKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 VICTORY PARKWAY
Mailing Address - Street 2:SUITE #500
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2809
Mailing Address - Country:US
Mailing Address - Phone:513-221-2330
Mailing Address - Fax:513-221-8954
Practice Address - Street 1:2330 VICTORY PARKWAY
Practice Address - Street 2:SUITE #500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2809
Practice Address - Country:US
Practice Address - Phone:513-221-2330
Practice Address - Fax:513-221-8954
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6079103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist