Provider Demographics
NPI:1043941768
Name:SPARKS, CASEY KATHLEEN (LMSW)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:KATHLEEN
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N SEGUIN AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6579
Mailing Address - Country:US
Mailing Address - Phone:830-200-0084
Mailing Address - Fax:
Practice Address - Street 1:200 N SEGUIN AVE STE 6
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6579
Practice Address - Country:US
Practice Address - Phone:830-200-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64214104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker