Healthcare Provider Details

I. General information

NPI: 1689550618
Provider Name (Legal Business Name): THRIVING MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9438 BASELINE.1 RD NE
MOSES LAKE WA
98837-9027
US

IV. Provider business mailing address

9438 BASELINE.1 RD NE
MOSES LAKE WA
98837-9027
US

V. Phone/Fax

Practice location:
  • Phone: 503-470-0502
  • Fax:
Mailing address:
  • Phone: 503-470-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELIZABETH INGRAM
Title or Position: MEMBER
Credential:
Phone: 503-470-0502