Organization
MISSOURI SPROUT MC 1 LLC
Active
Other names
Elemy
Organization subpart
No
Provider details
NPI number
Authorized official
YURY YAKUBCHYK SR. MD (OWNER)
(816) 307-1677
Entity
Organization
Contact information
Practice address
1828 WALNUT ST FL 3, KANSAS CITY, MO 64108-1835
(816) 307-1677
Mailing address
1828 WALNUT ST FL 3, KANSAS CITY, MO 64108-1835
(816) 307-1677
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
03/31/2020
Last updated
11/05/2021
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