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General NPI Number Information
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NPI Number | 1083342430
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Entity Type | Organization
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Legal Business Name | THRIVE THERAPY SERVICE, LLC
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 600 UNIVERSITY OFFICE BLVD STE B
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City | PENSACOLA
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State | FL
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Zip | 32504-6475
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Country | US
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Telephone | 850-483-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 2047 JOSHUA DR
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City | CANTONMENT
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State | FL
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Zip | 32533-4551
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Country | US
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Telephone | 850-748-1047
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Fax |
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Authorized Official
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Title or Position | OWNER & THERAPIST
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Name | JESSICA COOPER MAYO
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Credential | LMHC, RPT-S
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Telephone | 850-483-0023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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