MEDICARE: KATHERINE LOUSIE SPARKS LMHC

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	101YM0800X	Mental Health Counselor	004944	NY

General Provider Information

NPI Number	:	1427325901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE LOUSIE SPARKS LMHC

Provider Business Mailing Address
First Line	:	384 HILLSIDE PL
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2903
Country	:	US
Telephone Number	:	347-613-1790
Fax Number	:

Provider Business Practice Location Address
First Line	:	384 HILLSIDE PL
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2903
Country	:	US
Telephone Number	:	347-613-1790
Fax Number	:

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

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	10/30/2025

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