MEDICARE: SPROUTS ABA FOR ADULTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1538972518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPROUTS ABA FOR ADULTS LLC

Provider Business Mailing Address
First Line	:	778 KNOLLVIEW BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-4655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	778 KNOLLVIEW BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-4655
Country	:	US
Telephone Number	:	386-237-7144
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	CHRISTY ROSE MCGOVERN
Credential	:	M.ED., BCBA
Telephone Number	:	386-237-7144

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/31/2025

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