NPIMap

Organization Active NPI

Sprout Ventures, Inc.

Doing business as Sprout Clinics

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1144598228
Registry record updated Dec 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180.007708 Issued in IL
Legal business name
SPROUT VENTURES, INC.
Doing business as
Sprout Clinics
Practice address
221 E Cullerton St
Unit 101a
Chicago, IL 60616-1386
Phone
(312) 794-5582
Fax
(312) 794-5579
NPI assigned
Dec 5, 2011
Last updated
Dec 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephan Matthew Gombis, MSMFT, LCPC, BCNNPI 1699071142
Title
Executive Director
Phone
(312) 794-5582

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 180.007708 IL Primary

Addresses

Primary practice location

221 E Cullerton St
Unit 101a
Chicago, IL 60616-1386

Mailing address

221 E Cullerton St
Unit 101a
Chicago, IL 60616-1386
Phone (312) 794-5582

Other names 1

  • Sprout Clinics Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323043200000",
    "number": "1144598228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 E CULLERTON ST",
            "address_2": "UNIT 101A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606161386",
            "telephone_number": "312-794-5582",
            "fax_number": "312-794-5579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 E CULLERTON ST",
            "address_2": "UNIT 101A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606161386",
            "telephone_number": "312-794-5582",
            "fax_number": "312-794-5579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPROUT VENTURES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-05",
        "last_updated": "2011-12-05",
        "status": "A",
        "authorized_official_last_name": "GOMBIS",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "312-794-5582",
        "authorized_official_credential": "MSMFT, LCPC, BCN"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.007708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sprout Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.