Healthcare Provider Details

I. General information

NPI: 1245667443
Provider Name (Legal Business Name): THRIVE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 12/04/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47100 SCHOENHERR RD STE C
SHELBY TOWNSHIP MI
48315-4714
US

IV. Provider business mailing address

47100 SCHOENHERR RD STE C
SHELBY TOWNSHIP MI
48315-4714
US

V. Phone/Fax

Practice location:
  • Phone: 586-744-9026
  • Fax:
Mailing address:
  • Phone: 586-744-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014205
License Number StateMI

VIII. Authorized Official

Name: DR. AMY HANES
Title or Position: CEO
Credential: PSYD
Phone: 586-744-9026