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General NPI Number Information
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NPI Number | 1720739337
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Entity Type | Individual
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Provider Name | JACK SPARKS
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Gender | Female
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 7840 WASHINGTON AVE
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City | KANSAS CITY
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State | KS
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Zip | 66112-2152
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Country | US
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Telephone | 913-328-4708
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Fax |
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Provider Business Mailing Address
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Address Line | 7732 JEFFERSON ST
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City | KANSAS CITY
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State | MO
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Zip | 64114-1730
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Country | US
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Telephone | 816-588-9591
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 03989
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License Number State | KS
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