Provider Demographics
NPI:1245301712
Name:SPARK, BARBARA LYNN (RN, MFT)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LYNN
Last Name:SPARK
Suffix:
Gender:F
Credentials:RN, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20380 TOWN CENTER LN
Mailing Address - Street 2:SUITE A-107
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3210
Mailing Address - Country:US
Mailing Address - Phone:408-257-0823
Mailing Address - Fax:408-253-3215
Practice Address - Street 1:20380 TOWN CENTER LN
Practice Address - Street 2:SUITE A-107
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3210
Practice Address - Country:US
Practice Address - Phone:408-257-0823
Practice Address - Fax:408-253-3215
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist