MEDICARE: THRIVE TRANS YOUTH SOCAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1225992894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE TRANS YOUTH SOCAL

Provider Business Mailing Address
First Line	:	3931 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2614
Country	:	US
Telephone Number	:	562-420-2300
Fax Number	:	562-262-0675

Provider Business Practice Location Address
First Line	:	3931 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2614
Country	:	US
Telephone Number	:	562-420-2300
Fax Number	:	562-262-0675

Authorized Official
Title or Position	:	CLINICAL DIRECTOR/CLINICIAN
Name	:	MRS. BRIGITTE GISELE DUTIL
Credential	:	ATR, LPCC, LMFT
Telephone Number	:	562-420-2300

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “THRIVE TRANS YOUTH SOCAL ” Practice Location

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