Stacey Sparks, LPC
Individual provider Active NPI Professional Counselor · Maroa, IL
NPI 1508325176 · NPPES record last updated Mar 13, 2019
Key facts
- NPI
- 1508325176
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 178005202 (IL)
- Practice address
- 410 W Lincoln St
Maroa, IL 61756-9220 - Phone
- (217) 433-3002
- NPI assigned
- Mar 13, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178005202 | IL | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178005202 | IL | Yes |
Addresses
Primary practice location
410 W Lincoln St
Maroa, IL 61756-9220
Mailing address
410 W Lincoln St
Maroa, IL 61756-9220
Phone (217) 433-3002
Other providers in Maroa, IL
All providers in Maroa, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.