Theresa a. Sparks, PH.D., Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY9173 Issued in FL

Legal business name

THERESA A. SPARKS, PH.D., INC.

Practice address

910 S 8TH St Ste 134
Fernandina Beach, FL 32034-6700

Phone

(904) 891-4565

Fax

(904) 212-1216

NPI assigned

Jun 20, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Theresa A Sparks, PH.D.NPI 1538138367

Title

President/Owner

Phone

(904) 891-4565

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theresa A Sparks, PH.D.

  • Clinical Psychologist
  • Fernandina Beach, FL
  • NPI 1538138367
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1679955181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 S 8TH ST STE 134",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320346700",
            "telephone_number": "904-891-4565",
            "fax_number": "904-212-1216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 S 8TH ST STE 134",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320346700",
            "telephone_number": "904-891-4565",
            "fax_number": "904-212-1216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERESA A. SPARKS, PH.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-20",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "904-891-4565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9173",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY002794",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.