Most Relevant Information
Provider Data
| NPI Number: | 1003195793 |
| Provider Name: | JACQUELINE DENISE SPARKS |
| Entity Type: | Individual |
| Taxonomy Code: | 251S00000X |
| Specialty: | Community/Behavioral Health |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/11/2011 |
| Last Updated: | 08/11/2011 |
Provider Practice Location
12552 CANYON HILL DR
WILLIS
TX
773184641
Practice Location Phone/Fax
| Phone: | 9364459141 |
| Fax: |
Provider Mailing Location
12552 CANYON HILL DR
WILLIS
TX
773185742
Provider Mailing Phone/Fax
| Phone: | 9364459141 |
| Fax: |