MEDICARE: MS. PHYLLIS ANNETTE HAM L.C.P.C.

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	LC1640	MD

General Provider Information

NPI Number	:	1639443351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHYLLIS ANNETTE HAM L.C.P.C.

Provider Business Mailing Address
First Line	:	949 GORSUCH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-3602
Country	:	US
Telephone Number	:	410-467-4121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 OLD YORK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-1237
Country	:	US
Telephone Number	:	410-433-1458
Fax Number	:

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

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/27/2012

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