Provider Demographics
NPI:1497846273
Name:SPARKS, CODY G (LCP, LMLP, LMAC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:G
Last Name:SPARKS
Suffix:
Gender:M
Credentials:LCP, LMLP, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 ELMHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7405
Mailing Address - Country:US
Mailing Address - Phone:785-823-6322
Mailing Address - Fax:785-823-3109
Practice Address - Street 1:809 ELMHURST BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7405
Practice Address - Country:US
Practice Address - Phone:785-823-6322
Practice Address - Fax:785-823-3109
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0133103T00000X
KS131103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004437030001Medicaid
KS840687OtherBCBS