MEDICARE: MRS. SARAH DRUMMOND MACK 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	59425	TX

General Provider Information

NPI Number	:	1205295508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH DRUMMOND MACK LCSW

Provider Business Mailing Address
First Line	:	21432 QUAIL POINT LN
Second Line	:
City	:	PORTER
State	:	TX
Zip	:	77365-5180
Country	:	US
Telephone Number	:	832-658-5220
Fax Number	:	281-821-6863

Provider Business Practice Location Address
First Line	:	2003 WW THORNE BLVD
Second Line	:	#TM-01
City	:	HOUSTON
State	:	TX
Zip	:	77073-3301
Country	:	US
Telephone Number	:	832-658-5220
Fax Number	:	281-821-6863

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

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	03/14/2022

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