TN MC Sprout 1 LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

TN MC SPROUT 1 LLC

Doing business as

Elemy
Sprout Therapy

Practice address

424 Church St Ste 2000
Nashville, TN 37219-3304

Phone

(833) 991-2368

Fax

(929) 384-7193

NPI assigned

Mar 12, 2021

Last updated

Sep 27, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Yury Yakubchyk, MD

Title

Owner

Phone

(480) 591-7312

Specialties & licenses 1

Addresses

Other names 2

• Elemy Doing business as
• Sprout Therapy Doing business as

Locations

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

{
    "created_epoch": "1615507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1205411022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 CHURCH ST STE 2000",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372193304",
            "telephone_number": "833-991-2368",
            "fax_number": "929-384-7193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 CHURCH ST STE 2000",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372193304",
            "telephone_number": "833-991-2368",
            "fax_number": "929-384-7193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TN MC SPROUT 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-12",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "YAKUBCHYK",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-591-7312",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elemy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sprout Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Behavior Analyst in Nashville, TN
• Providers in Nashville, TN by specialty
• Behavior Analyst in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; 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.