Healthcare Provider Details

I. General information

NPI: 1912818535
Provider Name (Legal Business Name): THRIVEWELL BEHAVIOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N CENTENNIAL RD
HOLLAND OH
43528-9709
US

IV. Provider business mailing address

120 N CENTENNIAL RD
HOLLAND OH
43528-9709
US

V. Phone/Fax

Practice location:
  • Phone: 419-708-0603
  • Fax:
Mailing address:
  • Phone: 419-708-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. CALEB RICHARD WALLACE
Title or Position: FOUNDER/CEO
Credential:
Phone: 419-708-0603