1902441694 NPI number — SPROUT AND BLOSSOM COUNSELING CENTER

Table of content: LARISSA BURTON MSN, ARNP (NPI 1588226096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902441694 NPI number — SPROUT AND BLOSSOM COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPROUT AND BLOSSOM COUNSELING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902441694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1145 CREST MEADOW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASLET
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76052-6154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-658-2022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1090 SCHOOLHOUSE RD STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASLET
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76052-3777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-658-2022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
RITZ
Authorized Official First Name:
STEFANIE
Authorized Official Middle Name:
LUVELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-658-2022

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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