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General NPI Number Information
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NPI Number | 1295517381
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Entity Type | Organization
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Legal Business Name | SPROUT & GROW BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 843 MAIN ST
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City | TELL CITY
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State | IN
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Zip | 47586-2105
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Country | US
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Telephone | 812-772-2351
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Fax | 812-772-2571
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Provider Business Mailing Address
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Address Line | 843 MAIN ST
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City | TELL CITY
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State | IN
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Zip | 47586-2105
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Country | US
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Telephone | 812-772-2351
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Fax | 812-772-2571
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Authorized Official
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Title or Position | OWNER
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Name | KASSANDRA LEIGH RISSE
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Credential | BCBA
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Telephone | 214-300-8166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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