Provider Demographics
NPI:1881358901
Name:SPARROW PROFESSIONAL DEVELOPMENT & COUNSELING CENTER
Entity type:Organization
Organization Name:SPARROW PROFESSIONAL DEVELOPMENT & COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SLAD
Authorized Official - Middle Name:F
Authorized Official - Last Name:THACKERAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-910-6822
Mailing Address - Street 1:1151 SW LEVENS ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2266
Mailing Address - Country:US
Mailing Address - Phone:503-910-6822
Mailing Address - Fax:
Practice Address - Street 1:607 SE JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2025
Practice Address - Country:US
Practice Address - Phone:503-910-6822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty