MEDICARE: THRIVE THERAPY, INC.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1295290658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE THERAPY, INC.

Provider Business Mailing Address
First Line	:	12240 VENICE BLVD STE 26
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3891
Country	:	US
Telephone Number	:	310-699-6993
Fax Number	:

Provider Business Practice Location Address
First Line	:	12240 VENICE BLVD STE 26
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3891
Country	:	US
Telephone Number	:	323-999-1537
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMY MCMANUS
Credential	:
Telephone Number	:	323-999-1537

Provider Enumeration Date	:	02/09/2019
Last Update Date	:	02/09/2019

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Directions to “THRIVE THERAPY, INC. ” Practice Location

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