Provider Demographics
NPI:1760222418
Name:SPROUTS THERAPY LLC
Entity type:Organization
Organization Name:SPROUTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAEGON
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRADER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:817-247-5737
Mailing Address - Street 1:126 POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-9516
Mailing Address - Country:US
Mailing Address - Phone:817-247-5737
Mailing Address - Fax:
Practice Address - Street 1:126 POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9516
Practice Address - Country:US
Practice Address - Phone:817-247-5737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty