Healthcare Provider Details

I. General information

NPI: 1528331246
Provider Name (Legal Business Name): SEAN LEE SPARKS LMFT,80365
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY SPARKS LMFT,80365

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 N. CATALINA AVENUE
PASADENA CA
91106
US

IV. Provider business mailing address

69 N. CATALINA AVENUE
PASADENA CA
91106
US

V. Phone/Fax

Practice location:
  • Phone: 626-375-9586
  • Fax:
Mailing address:
  • Phone: 626-375-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT.80365
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: