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General NPI Number Information
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NPI Number | 1083165476
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Entity Type | Organization
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Legal Business Name | THRIVE COUNSELING SERVICES
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 6000 UPTOWN BLVD NE STE 305
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4148
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Country | US
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Telephone | 505-219-1125
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Fax | 505-393-4557
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Provider Business Mailing Address
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Address Line | 2308 GANDERT AVE SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-9607
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Country | US
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Telephone | 505-610-3610
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DEMIAN HUEMAC RUBALCABA
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Credential | LCSW
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Telephone | 505-610-3610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C-09049
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License Number State | NM
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