MEDICARE: MS. SOPHIA CHRISTINE BLACK

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	225A00000X	Music Therapist

General Provider Information

NPI Number	:	1053143594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SOPHIA CHRISTINE BLACK

Provider Business Mailing Address
First Line	:	16431 MILL POINT DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-5318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S FRIENDSWOOD DR STE 100
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-4543
Country	:	US
Telephone Number	:	281-947-2630
Fax Number	:

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

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	08/14/2024

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