Healthcare Provider Details

I. General information

NPI: 1952288995
Provider Name (Legal Business Name): THRIVING OAK WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 DOUGLAS LN
SEBASTOPOL CA
95472-2109
US

IV. Provider business mailing address

5270 DOUGLAS LN
SEBASTOPOL CA
95472-2109
US

V. Phone/Fax

Practice location:
  • Phone: 415-933-1901
  • Fax:
Mailing address:
  • Phone: 415-933-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIK PAUL ANTON DEITERS
Title or Position: PSYCHOTHERAPIST
Credential: LMFT
Phone: 415-933-1901