Healthcare Provider Details

I. General information

NPI: 1760148852
Provider Name (Legal Business Name): FLYING PIGS THRIVE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30605 MCCORMICK LN
WARRENVILLE IL
60555-3963
US

IV. Provider business mailing address

3S101 ROCKWELL ST UNIT 1331
WARRENVILLE IL
60555-3053
US

V. Phone/Fax

Practice location:
  • Phone: 224-622-3259
  • Fax:
Mailing address:
  • Phone: 224-622-3259
  • Fax:

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: TRUDE HOLLI
Title or Position: OWNER
Credential:
Phone: 224-622-3259