MEDICARE: DR. LUANNE SPARKS ED.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	3123	TX

General Provider Information

NPI Number	:	1376693135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUANNE SPARKS ED.D.

Provider Business Mailing Address
First Line	:	310 E INTERSTATE 30 STE M103
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-4047
Country	:	US
Telephone Number	:	972-270-0425
Fax Number	:	972-463-8107

Provider Business Practice Location Address
First Line	:	310 E INTERSTATE 30 STE M103
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-4047
Country	:	US
Telephone Number	:	972-270-0425
Fax Number	:	972-463-8107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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