Provider Demographics
NPI:1316760713
Name:SPROUT BEHAVIOR AND SKILLS THERAPY LLC
Entity type:Organization
Organization Name:SPROUT BEHAVIOR AND SKILLS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:405-887-5719
Mailing Address - Street 1:5717 NW 115TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-3545
Mailing Address - Country:US
Mailing Address - Phone:405-887-5719
Mailing Address - Fax:
Practice Address - Street 1:5717 NW 115TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-3545
Practice Address - Country:US
Practice Address - Phone:405-887-5719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty