Provider Demographics
NPI:1316414865
Name:SPARKS, SEAN (MS, LPC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:SPARKS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 EASTCREST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-2440
Mailing Address - Country:US
Mailing Address - Phone:682-251-8596
Mailing Address - Fax:
Practice Address - Street 1:3705 MEDICAL PKWY STE 520
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1029
Practice Address - Country:US
Practice Address - Phone:940-220-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty