MEDICARE: SPARKLE AGNES HAMILTON MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	66440	TX

General Provider Information

NPI Number	:	1184974412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPARKLE AGNES HAMILTON MA, LPC

Provider Business Mailing Address
First Line	:	5411 JACKSON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5928
Country	:	US
Telephone Number	:	713-334-4134
Fax Number	:

Provider Business Practice Location Address
First Line	:	2902 MILROY LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-4610
Country	:	US
Telephone Number	:	281-580-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	09/13/2012

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