Healthcare Provider Details

I. General information

NPI: 1922929041
Provider Name (Legal Business Name): THRIVEMIND PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 PAY IT FORWARD DR APT 104
CASPER WY
82609-4496
US

IV. Provider business mailing address

6 LIBERTY SQ
BOSTON MA
02109-5800
US

V. Phone/Fax

Practice location:
  • Phone: 603-726-1240
  • Fax:
Mailing address:
  • Phone: 603-726-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CARISA BISHOP
Title or Position: OWNER
Credential: LICSW
Phone: 617-468-7811