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General NPI Number Information
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NPI Number | 1205537826
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Entity Type | Organization
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Legal Business Name | FAMILY THRIVE INC
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Dates
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Enumeration Date | 03/10/2023
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 260 E 90TH DR
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City | MERRILLVILLE
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State | IN
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Zip | 46410-8102
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Country | US
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Telephone | 219-808-0296
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Fax |
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Provider Business Mailing Address
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Address Line | 10629 ERIE DR
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City | CROWN POINT
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State | IN
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Zip | 46307-9488
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Country | US
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Telephone | 219-808-0296
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FARHAD HATAMI
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Credential |
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Telephone | 219-808-0296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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