Provider Demographics
NPI:1790593150
Name:SPRATLING, JIM
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:SPRATLING
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 1:3661 PONDEROSA RD
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9460
Mailing Address - Country:US
Mailing Address - Phone:530-677-2281
Mailing Address - Fax:
Practice Address - Street 1:3661 PONDEROSA RD
Practice Address - Street 2:
Practice Address - City:SHINGLE SPGS
Practice Address - State:CA
Practice Address - Zip Code:95682-9460
Practice Address - Country:US
Practice Address - Phone:530-677-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool