Healthcare Provider Details

I. General information

NPI: 1194265199
Provider Name (Legal Business Name): DARYL SPARKS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DARYL SPARKS PSY.D.

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 WILLOW CREEK RD STE A101
PRESCOTT AZ
86301-1672
US

IV. Provider business mailing address

1042 WILLOW CREEK RD STE A101
PRESCOTT AZ
86301-1672
US

V. Phone/Fax

Practice location:
  • Phone: 734-926-5667
  • Fax:
Mailing address:
  • Phone: 734-926-5667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number94024833
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-006005
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: