Healthcare Provider Details

I. General information

NPI: 1619897519
Provider Name (Legal Business Name): CASA SPROUT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 POLK ST
HOLLYWOOD FL
33021-6430
US

IV. Provider business mailing address

5430 POLK ST
HOLLYWOOD FL
33021-6430
US

V. Phone/Fax

Practice location:
  • Phone: 305-333-3268
  • Fax:
Mailing address:
  • Phone: 305-333-3268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: OLGA L RODRIGUEZ
Title or Position: MANAGING MEMBER
Credential: LMHC
Phone: 305-333-3268