Healthcare Provider Details

I. General information

NPI: 1346534393
Provider Name (Legal Business Name): JACOB SPARKS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12569 S 2700 W
RIVERTON UT
84065-7182
US

IV. Provider business mailing address

12569 S 2700 W
RIVERTON UT
84065-7182
US

V. Phone/Fax

Practice location:
  • Phone: 801-643-4846
  • Fax:
Mailing address:
  • Phone: 801-209-9797
  • Fax: 801-206-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number8565462-3902
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberBBH-LMFT-LIC-12233
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: