Provider Demographics
NPI:1811493935
Name:SPARKS, ALBERT TODD (MSCC)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:TODD
Last Name:SPARKS
Suffix:
Gender:M
Credentials:MSCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6821
Mailing Address - Country:US
Mailing Address - Phone:402-393-6911
Mailing Address - Fax:402-393-7838
Practice Address - Street 1:1941 S 42ND ST STE 538
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2945
Practice Address - Country:US
Practice Address - Phone:402-788-4846
Practice Address - Fax:402-702-0664
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health