Provider Demographics
NPI:1942481114
Name:SPARKS, JENNIFER (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SPARKS
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 1:675 AUSTIN LN
Mailing Address - Street 2:
Mailing Address - City:LAVON
Mailing Address - State:TX
Mailing Address - Zip Code:75166-1772
Mailing Address - Country:US
Mailing Address - Phone:972-679-3445
Mailing Address - Fax:972-781-0203
Practice Address - Street 1:2800 N DALLAS PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5993
Practice Address - Country:US
Practice Address - Phone:972-679-3445
Practice Address - Fax:972-781-0203
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional