Individual
JACQUELINE DENISE SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12552 CANYON HILL DR, WILLIS, TX 77318-4641
(936) 445-9141
Mailing address
12552 CANYON HILL DR, WILLIS, TX 77318-5742
(936) 445-9141
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/11/2011
Last updated
08/11/2011
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