Provider Demographics
NPI:1548346562
Name:SPARKS, LISA KATHRYN (MS LPC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:KATHRYN
Last Name:SPARKS
Suffix:
Gender:F
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 1:2 NORTH WATER ST.
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066
Mailing Address - Country:US
Mailing Address - Phone:918-224-0225
Mailing Address - Fax:918-224-5975
Practice Address - Street 1:2 N WATER ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-2816
Practice Address - Country:US
Practice Address - Phone:918-224-0225
Practice Address - Fax:918-224-5975
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health