Provider Demographics
NPI:1871678425
Name:SPARKMAN, LILA G (PHD LCSW LPC LMFT)
Entity Type:Individual
Prefix:DR
First Name:LILA
Middle Name:G
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:PHD LCSW LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CR 4310
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494
Mailing Address - Country:US
Mailing Address - Phone:903-342-6852
Mailing Address - Fax:903-342-0855
Practice Address - Street 1:101 NORTH MAIN ST SUITE 209
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494
Practice Address - Country:US
Practice Address - Phone:903-342-6852
Practice Address - Fax:903-342-0855
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9246101YP2500X
TX016741041C0700X
TX0965042156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00133827OtherRAILROAD MEDICARE
TX00515PMedicare ID - Type Unspecified