=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205568201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIVE COUNSELING AND WELLNESS GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2022
-----------------------------------------------------
Last Update Date | 06/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 PEACH ORCHARD RD
-----------------------------------------------------
City | PROSPECT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06712-1052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-693-1883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 NELSON BROOK RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06468-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-693-1883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | LAURA GALINDO
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 203-693-1883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------