Provider Demographics
NPI:1457190969
Name:SPROUT THERAPY PDX
Entity type:Organization
Organization Name:SPROUT THERAPY PDX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-954-6006
Mailing Address - Street 1:10204 SW CONESTOGA DR APT 19
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8419
Mailing Address - Country:US
Mailing Address - Phone:541-954-6006
Mailing Address - Fax:
Practice Address - Street 1:7704 N HEREFORD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3434
Practice Address - Country:US
Practice Address - Phone:971-319-4827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty