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Organization
TX MC SPROUT 1 PLLC
Active
Organization
TX MC SPROUT 1 PLLC
Active
Other names
Tilly, Elemy
Organization subpart
No
Provider details
NPI number
Authorized official
YURY YAKUBCHYK SR. (OWNER)
(469) 904-0159
Entity
Organization
Contact information
Practice address
325 N SAINT PAUL ST STE 3100, DALLAS, TX 75201-3923
(626) 699-0236
(929) 384-7193
Mailing address
19 W 24TH ST FL 4, NEW YORK, NY 10010-3239
(833) 458-0386
(855) 461-3542
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106E00000X
Assistant Behavior Analyst
—
—
Other
Enumeration date
04/03/2020
Last updated
06/24/2025
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