Provider Demographics
NPI:1780212282
Name:SPROUT THERAPY GROUP, PLLC
Entity Type:Organization
Organization Name:SPROUT THERAPY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS MILLICAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:843-743-5636
Mailing Address - Street 1:1800 154TH AVE NE APT E240
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4381
Mailing Address - Country:US
Mailing Address - Phone:843-743-5636
Mailing Address - Fax:
Practice Address - Street 1:1800 154TH AVE NE APT E240
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4381
Practice Address - Country:US
Practice Address - Phone:843-743-5636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty