Healthcare Provider Details

I. General information

NPI: 1811699176
Provider Name (Legal Business Name): THRIVE THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CIVIC HEIGHTS DR
CIRCLE PINES MN
55014-4711
US

IV. Provider business mailing address

620 CIVIC HEIGHTS DR
CIRCLE PINES MN
55014-4711
US

V. Phone/Fax

Practice location:
  • Phone: 763-248-0352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELLY LEMM
Title or Position: OWNER
Credential:
Phone: 612-501-5242