Provider Demographics
NPI:1992163315
Name:SPROUT BEHAVIOR CONSULTANTS, LLC
Entity type:Organization
Organization Name:SPROUT BEHAVIOR CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN MERCIER
Authorized Official - Last Name:COOKSEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:941-737-8539
Mailing Address - Street 1:PO BOX 61744
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-1744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10181 6 MILE CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-6401
Practice Address - Country:US
Practice Address - Phone:941-737-8539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health