Individual
JACOB SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
77 TRAILS END RD, EUREKA, MT 59917
(801) 643-4846
Mailing address
77 TRAILS END RD, EUREKA, MT 59917-9332
(801) 643-4846
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
BBH-LMFT-LIC-12233
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BBH-LMFT-LIC-12233
—
MT
Enumeration date
06/07/2011
Last updated
09/12/2019
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