MEDICARE: MR. JAMES SHELDON SARGENT LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10601	TX

General Provider Information

NPI Number	:	1164717914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES SHELDON SARGENT LCDC

Provider Business Mailing Address
First Line	:	550 WESTCOTT ST
Second Line	:	SUITE 420
City	:	HOUSTON
State	:	TX
Zip	:	77007-9015
Country	:	US
Telephone Number	:	713-962-6240
Fax Number	:

Provider Business Practice Location Address
First Line	:	10010 KEMPWOOD DR
Second Line	:	#126
City	:	HOUSTON
State	:	TX
Zip	:	77080-2694
Country	:	US
Telephone Number	:	713-962-6240
Fax Number	:

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

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	06/09/2011

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