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NPI Code Detail

MEDICARE: KELSEY MARIE SPARKS BCBA

MEDICARE: KELSEY MARIE SPARKS BCBA
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
1103K00000XBehavior Analyst1-21-51131TX

General Provider Information

NPI Number : 1619503471
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY MARIE SPARKS BCBA
Provider Business Mailing Address
First Line : 7500 SAN FELIPE ST STE 990
Second Line :
City : HOUSTON
State : TX
Zip : 77063-1708
Country : US
Telephone Number : 281-826-3382
Fax Number :
Provider Business Practice Location Address
First Line : 6824 LOGUE LN
Second Line :
City : WACO
State : TX
Zip : 76708-7241
Country : US
Telephone Number : 125-464-4848
Fax Number : 254-756-3133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2020
Last Update Date : 02/08/2023

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Directions to “ KELSEY MARIE SPARKS BCBA” Practice Location

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