Healthcare Provider Details

I. General information

NPI: 1548860968
Provider Name (Legal Business Name): THRIVING LIFESTYLES COUNSELING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 1 STREET
COLONA IL
61241
US

IV. Provider business mailing address

629 11TH ST
SILVIS IL
61282-1553
US

V. Phone/Fax

Practice location:
  • Phone: 309-431-1555
  • Fax: 855-515-0810
Mailing address:
  • Phone: 309-431-1555
  • Fax: 855-515-0810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAURA NUNEZ
Title or Position: OWNER
Credential: LMFT
Phone: 309-431-1555