Provider Demographics
NPI:1154550861
Name:SPARKS, MISTI
Entity type:Individual
Prefix:DR
First Name:MISTI
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10332 FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7588
Mailing Address - Country:US
Mailing Address - Phone:940-368-6748
Mailing Address - Fax:
Practice Address - Street 1:6136 FRISCO SQUARE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3246
Practice Address - Country:US
Practice Address - Phone:469-323-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist