Provider Demographics
NPI:1891160636
Name:SPARKS, JESSICA (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:1562 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1616
Mailing Address - Country:US
Mailing Address - Phone:408-313-0945
Mailing Address - Fax:
Practice Address - Street 1:20863 STEVENS CREEK BLVD STE 580
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2197
Practice Address - Country:US
Practice Address - Phone:408-342-0612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110797106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist