Healthcare Provider Details

I. General information

NPI: 1871082115
Provider Name (Legal Business Name): THRIVE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 WOODLAND ST NE
WARREN OH
44483-5348
US

IV. Provider business mailing address

1705 WOODLAND ST NE
WARREN OH
44483-5348
US

V. Phone/Fax

Practice location:
  • Phone: 330-469-6777
  • Fax:
Mailing address:
  • Phone: 330-469-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGEL OLIVIA PIXLEY
Title or Position: CO-OWNER/ BUSINESS DIRECTOR
Credential:
Phone: 330-469-5702