Provider Demographics
NPI:1578950085
Name:SPROUTING 4 LIFE
Entity Type:Organization
Organization Name:SPROUTING 4 LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, AT
Authorized Official - Phone:210-590-0377
Mailing Address - Street 1:8930 FOURWINDS DR
Mailing Address - Street 2:STE 211
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78239-1970
Mailing Address - Country:US
Mailing Address - Phone:210-590-0377
Mailing Address - Fax:210-590-0381
Practice Address - Street 1:8930 FOURWINDS DR
Practice Address - Street 2:STE 211
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-1970
Practice Address - Country:US
Practice Address - Phone:210-590-0377
Practice Address - Fax:210-590-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty