Healthcare Provider Details

I. General information

NPI: 1538972518
Provider Name (Legal Business Name): SPROUTS ABA FOR ADULTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 KNOLLVIEW BLVD
ORMOND BEACH FL
32174-4655
US

IV. Provider business mailing address

778 KNOLLVIEW BLVD
ORMOND BEACH FL
32174-4655
US

V. Phone/Fax

Practice location:
  • Phone: 386-237-7144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

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