Provider Demographics
NPI:1902441694
Name:SPROUT AND BLOSSOM COUNSELING CENTER
Entity Type:Organization
Organization Name:SPROUT AND BLOSSOM COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:LUVELLE
Authorized Official - Last Name:RITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-658-2022
Mailing Address - Street 1:1145 CREST MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-6154
Mailing Address - Country:US
Mailing Address - Phone:817-658-2022
Mailing Address - Fax:
Practice Address - Street 1:1090 SCHOOLHOUSE RD STE 600
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-3777
Practice Address - Country:US
Practice Address - Phone:817-658-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty