Healthcare Provider Details

I. General information

NPI: 1750923249
Provider Name (Legal Business Name): PATRICK RAYMOND SPARKS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RUPERT ST
MONTE VISTA CO
81144-1042
US

IV. Provider business mailing address

7108 SOUTH KANNER HWY
STUART FL
34997
US

V. Phone/Fax

Practice location:
  • Phone: 719-852-3742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-53699
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: