Healthcare Provider Details

I. General information

NPI: 1073452751
Provider Name (Legal Business Name): THRIVESPACE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 N MAIN ST
SPANISH FORK UT
84660-1113
US

IV. Provider business mailing address

765 N MAIN ST
SPANISH FORK UT
84660-1113
US

V. Phone/Fax

Practice location:
  • Phone: 801-228-8866
  • Fax:
Mailing address:
  • Phone: 801-228-8866
  • Fax:

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: MICHELLE RAWLS RAWLS
Title or Position: OWNER
Credential: PMHNP
Phone: 801-228-8866