Healthcare Provider Details

I. General information

NPI: 1952723538
Provider Name (Legal Business Name): THRIVE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BROADWAY ST STE 230
VANCOUVER WA
98660-3320
US

IV. Provider business mailing address

1101 BROADWAY ST STE 230
VANCOUVER WA
98660-3320
US

V. Phone/Fax

Practice location:
  • Phone: 360-719-2852
  • Fax: 888-808-8143
Mailing address:
  • Phone:
  • Fax: 888-808-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00003931
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00002510
License Number StateWA

VIII. Authorized Official

Name: AMANDA V WEATHERBY
Title or Position: PRESIDENT/LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 360-719-2852