Organization
OR MC SPROUT 1 LLC
Active
Other names
Elemy, Sprout Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
YURY YAKUBCHYK SR. (OWNER)
(786) 210-8200
Entity
Organization
Contact information
Practice address
10260 SW GREENBURG RD FL 4, PORTLAND, OR 97223-5500
(833) 991-7193
(929) 384-7193
Mailing address
10260 SW GREENBURG RD FL 4, PORTLAND, OR 97223-5500
(833) 991-7193
(929) 384-7193
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
06/05/2020
Last updated
09/27/2021
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