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Organization
ELEMY IOP LLC
Active
Organization
ELEMY IOP LLC
Active
Parent organization
FL MC SPROUT 1 LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FL MC SPROUT 1 LLC
Authorized official
YURY YAKUBCHYK (CEO)
(833) 458-0386
Entity
Organization
Contact information
Practice address
6303 BLUE LAGOON DR STE 400, MIAMI, FL 33126-6040
(833) 458-0386
Mailing address
6303 BLUE LAGOON DR STE 400, MIAMI, FL 33126-6040
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
07/08/2022
Last updated
07/08/2022
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