MEDICARE: THRIVE FOR LIFE COUNSELING, LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1912594920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE FOR LIFE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	13 PINE MEADOW DR
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-8354
Country	:	US
Telephone Number	:	317-426-8582
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 PINE MEADOW DR
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-8354
Country	:	US
Telephone Number	:	317-426-8582
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WENDY BEHNKENDORF GALYEN
Credential	:	LCSW
Telephone Number	:	317-426-8582

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	12/23/2020

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