Healthcare Provider Details

I. General information

NPI: 1629544903
Provider Name (Legal Business Name): THRIVE INTEGRATIVE PSYCHIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 02/06/2022
Certification Date: 02/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 NW 8TH ST
MCMINNVILLE OR
97128-5560
US

IV. Provider business mailing address

117 NW 8TH ST
MCMINNVILLE OR
97128-5560
US

V. Phone/Fax

Practice location:
  • Phone: 503-379-0208
  • Fax: 503-662-6068
Mailing address:
  • Phone: 503-379-0208
  • Fax: 503-662-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BEHNKE
Title or Position: PRESIDENT
Credential: PMHNP
Phone: 503-916-9898