Healthcare Provider Details

I. General information

NPI: 1598688129
Provider Name (Legal Business Name): FLOURISH & THRIVE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MADISON AVE
FORT ATKINSON WI
53538-1444
US

IV. Provider business mailing address

511 MADISON AVE
FORT ATKINSON WI
53538-1444
US

V. Phone/Fax

Practice location:
  • Phone: 920-541-3078
  • Fax:
Mailing address:
  • Phone: 920-541-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY HEINE
Title or Position: MBR
Credential: LPC
Phone: 920-723-9747