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General NPI Number Information
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NPI Number | 1992163315
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Entity Type | Organization
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Legal Business Name | SPROUT BEHAVIOR CONSULTANTS, LLC
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 10181 6 MILE CYPRESS PKWY
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City | FORT MYERS
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State | FL
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Zip | 33966-6401
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Country | US
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Telephone | 941-737-8539
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 61744
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City | FORT MYERS
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State | FL
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Zip | 33906-1744
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BCBA/OWNER
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Name | STEPHANIE ANN MERCIER COOKSEY
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Credential | BCBA
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Telephone | 941-737-8539
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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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