Active NPI
Jennifer Michelle Sparks
- Mental Health Counselor
- Costa Mesa, CA
National Provider Identifier
1407176944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 611 Shasta Lane
Suite 100
Costa Mesa, CA 92626 - Phone
- (714) 803-9181
- NPI assigned
- Jun 7, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
611 Shasta Lane
Suite 100
Costa Mesa, CA 92626
Mailing address
611 Shasta Lane
Suite 100
Costa Mesa, CA 92626
Phone (714) 803-9181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308009600000",
"number": "1407176944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 SHASTA LANE",
"address_2": "SUITE 100",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "92626",
"telephone_number": "714-803-9181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 SHASTA LANE",
"address_2": "SUITE 100",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "92626",
"telephone_number": "714-803-9181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPARKS",
"first_name": "JENNIFER",
"middle_name": "MICHELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-07",
"last_updated": "2011-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
- Southern California Alcohol & Drug Programs, Inc. (Heritage House)
- Southern California Orthopedic & Rehab Specialists
- Southern California Portable X-Ray &Ekg
- Southwest Science Labs LLC
- Diamonique Sparks
- Jordyn Eileen Sparks
- Kamden Elizabeth Spector
- Jahquon Tyler Speed
- Mari Luisa Spencer, RN, BSN
- Spicer Chiropractic Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.