Provider Demographics
NPI:1700654464
Name:SPARKS, JAMES DANIEL
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIEL
Last Name:SPARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29970 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2645
Mailing Address - Country:US
Mailing Address - Phone:951-900-4414
Mailing Address - Fax:951-880-0817
Practice Address - Street 1:29970 TECHNOLOGY DR STE 108
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2646
Practice Address - Country:US
Practice Address - Phone:951-900-4414
Practice Address - Fax:951-880-0817
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT134185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional