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General NPI Number Information
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NPI Number | 1164393955
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Entity Type | Organization
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Legal Business Name | THRIVE WELLNESS & PERFORMANCE
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 4 TERRY DR STE 1
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City | NEWTOWN
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State | PA
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Zip | 18940-1838
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Country | US
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Telephone | 610-716-6368
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Fax |
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Provider Business Mailing Address
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Address Line | 930 MONTGOMERY AVE APT 601
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City | BRYN MAWR
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State | PA
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Zip | 19010-3041
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Country | US
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Telephone | 610-716-6368
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | MELISSA GRAHAM
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Credential | LPC
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Telephone | 610-716-6368
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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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