MEDICARE: THOMAS L HAMBLETON LCSW

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	1041C0700X	Clinical Social Worker	10166	TX

General Provider Information

NPI Number	:	1003383985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS L HAMBLETON LCSW

Provider Business Mailing Address
First Line	:	3100 WESLAYAN ST STE 350
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5733
Country	:	US
Telephone Number	:	713-963-0769
Fax Number	:	713-963-8536

Provider Business Practice Location Address
First Line	:	3100 WESLAYAN ST STE 350
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5733
Country	:	US
Telephone Number	:	713-963-0769
Fax Number	:	713-963-8536

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

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	10/29/2018

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Directions to “ THOMAS L HAMBLETON LCSW” Practice Location

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