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General NPI Number Information
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NPI Number | 1134287857
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Entity Type | Organization
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Legal Business Name | SPARKER, INC.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 8857 META HWY META MEDICAL CENTER
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City | PIKEVILLE
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State | KY
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Zip | 41501
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Country | US
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Telephone | 606-631-1222
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Fax | 606-631-1226
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Provider Business Mailing Address
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Address Line | 8857 META HWY META MEDICAL CENTER
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City | PIKEVILLE
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State | KY
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Zip | 41501
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Country | US
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Telephone | 606-631-1222
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Fax | 606-631-1226
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TYLER BLAYLOCK
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Credential |
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Telephone | 606-631-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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