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General NPI Number Information
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NPI Number | 1578182036
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Entity Type | Organization
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Legal Business Name | IL SPROUT MC 1 LLC
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 125 S WACKER DR STE 300
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City | CHICAGO
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State | IL
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Zip | 60606-4421
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Country | US
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Telephone | 833-458-0386
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Fax | 855-461-3542
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Provider Business Mailing Address
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Address Line | 19 W 24TH ST FL 4
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City | NEW YORK
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State | NY
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Zip | 10010-3239
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Country | US
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Telephone | 833-458-0386
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Fax | 855-461-3542
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Authorized Official
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Title or Position | OWNER
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Name | YURY YAKUBCHYK SR.
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Credential |
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Telephone | 312-820-9715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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