Healthcare Provider Details

I. General information

NPI: 1235965310
Provider Name (Legal Business Name): THRIVE FAMILY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 S CHARLESTON AVE
SPRINGFIELD MO
65804-4370
US

IV. Provider business mailing address

PO BOX 288
ROGERSVILLE MO
65742-0288
US

V. Phone/Fax

Practice location:
  • Phone: 417-844-3533
  • Fax:
Mailing address:
  • Phone: 417-844-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMANDA ACREE
Title or Position: OWNER
Credential:
Phone: 417-844-3533