Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1205964392 |
---|---|
Provider Name | Mr. William Earl Sparks JR. |
First Address | San Luis Obispo, CA 93406-5408 |
Second Address | San Luis Obispo, CA 93401-5243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 28/04/2015 |