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General NPI Number Information
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NPI Number | 1003635970
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Entity Type | Organization
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Legal Business Name | THRIVING MINDS PSYCHOTHERAPY SERVICES LLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 3088 SHEFFIELD ST STE A
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City | NORTON SHORES
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State | MI
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Zip | 49441-4290
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Country | US
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Telephone | 231-737-1212
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Fax | 231-737-1218
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Provider Business Mailing Address
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Address Line | 465 S BEAR LAKE RD
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City | NORTH MUSKEGON
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State | MI
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Zip | 49445-2797
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Country | US
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Telephone | 231-855-0210
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY M DYE
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Credential | LCSW, LMSW
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Telephone | 231-855-0210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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