Healthcare Provider Details

I. General information

NPI: 1801180328
Provider Name (Legal Business Name): BEVERLY ANN SPARKMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DR, JBSA-FT. SAM HOUSTON
SAN ANTONIO TX
78234-4504
US

IV. Provider business mailing address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DR., JBSA-FT. SAM HOUSTON
SAN ANTONIO TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-5792
  • Fax: 210-916-5102
Mailing address:
  • Phone: 210-916-5792
  • Fax: 210-916-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number41260
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: