MEDICARE: SPARROW COUNSELING LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164285995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARROW COUNSELING LLC

Provider Business Mailing Address
First Line	:	5019 S BUR OAK PL
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2228
Country	:	US
Telephone Number	:	605-307-5443
Fax Number	:	605-309-8134

Provider Business Practice Location Address
First Line	:	5019 S BUR OAK PL
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2228
Country	:	US
Telephone Number	:	605-307-5443
Fax Number	:	605-309-8134

Authorized Official
Title or Position	:	THERAPIST
Name	:	MRS. ALYSSA HOWE
Credential	:	LPC-MH, LAC, QMHP
Telephone Number	:	605-307-5443

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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