Healthcare Provider Details

I. General information

NPI: 1508728486
Provider Name (Legal Business Name): SPECTHRIVE WELLNESS & BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 NORTHLAND CIR N STE 104-H
BROOKLYN PARK MN
55428-1548
US

IV. Provider business mailing address

7960 ORCHID LN N
MAPLE GROVE MN
55311-2186
US

V. Phone/Fax

Practice location:
  • Phone: 612-208-6549
  • Fax:
Mailing address:
  • Phone: 612-807-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: NANCY NYABUTI
Title or Position: THERAPIST/COUNSELOR
Credential: MA
Phone: 612-807-0456