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General NPI Number Information
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NPI Number | 1881358901
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Entity Type | Organization
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Legal Business Name | SPARROW PROFESSIONAL DEVELOPMENT & COUNSELING CENTER
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 607 SE JEFFERSON ST
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City | DALLAS
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State | OR
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Zip | 97338-2025
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Country | US
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Telephone | 503-910-6822
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Fax |
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Provider Business Mailing Address
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Address Line | 1151 SW LEVENS ST
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City | DALLAS
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State | OR
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Zip | 97338-2266
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Country | US
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Telephone | 503-910-6822
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | SLAD F THACKERAY
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Credential |
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Telephone | 503-910-6822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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