Healthcare Provider Details

I. General information

NPI: 1518874445
Provider Name (Legal Business Name): THRIVE FORWARD BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 W 21ST PL
CHICAGO IL
60608-4898
US

IV. Provider business mailing address

2022 W 21ST PL
CHICAGO IL
60608-4898
US

V. Phone/Fax

Practice location:
  • Phone: 773-801-4323
  • Fax:
Mailing address:
  • Phone: 773-801-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SONNY CARLOS GARRETT GRAHAM
Title or Position: EXECUTIVE DIRECTOR
Credential: BSW
Phone: 773-801-4323