Healthcare Provider Details

I. General information

NPI: 1659884757
Provider Name (Legal Business Name): THRIVE COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 11/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 LAKEVIEW PKWY STE 180
VERNON HILLS IL
60061-1429
US

IV. Provider business mailing address

977 LAKEVIEW PKWY STE 180
VERNON HILLS IL
60061-1429
US

V. Phone/Fax

Practice location:
  • Phone: 224-419-4088
  • Fax: 847-549-8006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008743
License Number StateIL

VIII. Authorized Official

Name: LYDIA TRACY
Title or Position: OWNER
Credential:
Phone: 224-419-4088