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General NPI Number Information
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NPI Number | 1336658913
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Entity Type | Individual
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Provider Name | JESSICA SHANNON SPARGUR M. A.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 5 MAREBLU
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3014
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Country | US
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Telephone | 949-643-6901
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4401
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92605-4401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 117409
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License Number State | CA
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