Wa MC Sprout 1 LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

WA MC SPROUT 1 LLC

Practice address

100 S King St Ste 100-1023
Seattle, WA 98104-3844

Phone

(206) 278-4342

Fax

(929) 384-7193

NPI assigned

Apr 14, 2020

Organization subpart

No

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

Authorized official

Name

Yury Yakubchyk Sr.

Title

Owner

Phone

(206) 278-4342

Specialties & licenses 1

Addresses

Other names 2

• Elemy Doing business as
• Sprout Therapy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacquelyn Erlene Flood, PSY.D.

  • Clinical Psychologist
  • Lutz, FL
  • NPI 1548430960
  NPD (past)

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

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1881213429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S KING ST STE 100-1023",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043844",
            "telephone_number": "206-278-4342",
            "fax_number": "929-384-7193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S KING ST STE 100-1023",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043844",
            "telephone_number": "206-278-4342",
            "fax_number": "929-384-7193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WA MC SPROUT 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-14",
        "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": "206-278-4342",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "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"
        }
    ]
}

• Sydney Vyas
• Alexis Vyrostek-Roettger, OTD, OTR/L
• W Gene Beck Jr P.L.L.C
• W.C.C.P.S.
• Wa Asian/Pacific Islander Families Against Substance Abuse
• Waaf PLLC
• Sumathi Wable, M.D.
• Joseph Njuguna Wachira
• Anna M Wachtel, M.S., OTR/L
• Bruce Bartja Wachtel, LICSW

• Behavior Analyst in Seattle, WA
• Providers in Seattle, WA by specialty
• Behavior Analyst in Washington

• 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.