Healthcare Provider Details

I. General information

NPI: 1538099304
Provider Name (Legal Business Name): THRIVE NEURO WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67156 LOCKE ST
MANDEVILLE LA
70471-6910
US

IV. Provider business mailing address

67156 LOCKE ST
MANDEVILLE LA
70471-6910
US

V. Phone/Fax

Practice location:
  • Phone: 504-343-7052
  • Fax:
Mailing address:
  • Phone: 504-343-7052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DANA MCKINNEY
Title or Position: SPEECH LANGUAGE PATHOLOGIST/OWNER
Credential:
Phone: 504-343-7052