Healthcare Provider Details

I. General information

NPI: 1295398378
Provider Name (Legal Business Name): THRIVE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 S CLINTON ST
IOWA CITY IA
52240-4212
US

IV. Provider business mailing address

516 S CLINTON ST
IOWA CITY IA
52240-4212
US

V. Phone/Fax

Practice location:
  • Phone: 319-569-1710
  • Fax:
Mailing address:
  • Phone: 319-569-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. LANAYA L ETHINGTON
Title or Position: CO-OWNER
Credential: PHD
Phone: 319-569-1710