Healthcare Provider Details

I. General information

NPI: 1720778228
Provider Name (Legal Business Name): THRIVING MINDS ACADEMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 S SUNSET RD
APACHE JUNCTION AZ
85119-7823
US

IV. Provider business mailing address

151 W SUPERSTITION BLVD UNIT 4471
APACHE JUNCTION AZ
85178-6020
US

V. Phone/Fax

Practice location:
  • Phone: 480-806-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DANIEL GIBBS
Title or Position: OWNER
Credential:
Phone: 480-806-8000