Provider Demographics
NPI:1316434459
Name:SPARKS, TREVOR ALAN
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:ALAN
Last Name:SPARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LAKLOEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5356
Mailing Address - Country:US
Mailing Address - Phone:907-978-5766
Mailing Address - Fax:
Practice Address - Street 1:960 LAKLOEY DR
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-5356
Practice Address - Country:US
Practice Address - Phone:907-978-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician