Healthcare Provider Details

I. General information

NPI: 1376485615
Provider Name (Legal Business Name): THRIVE WITHIN PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E GLENSIDE AVE # 1027
GLENSIDE PA
19038-4534
US

IV. Provider business mailing address

140 E GLENSIDE AVE # 1027
GLENSIDE PA
19038-4534
US

V. Phone/Fax

Practice location:
  • Phone: 267-730-4980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KEYONI L ROGERS
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 267-730-4980