Healthcare Provider Details

I. General information

NPI: 1821789843
Provider Name (Legal Business Name): THRIVE NEUROPSYCHOLOGY & PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALIENTE RD UNIT 1
SANTA FE NM
87508-9209
US

IV. Provider business mailing address

28 ENCANTADO RD
SANTA FE NM
87508-1394
US

V. Phone/Fax

Practice location:
  • Phone: 323-620-2834
  • Fax:
Mailing address:
  • Phone: 323-620-2834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LARA HEFLIN
Title or Position: OWNER/CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 323-620-2834