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General NPI Number Information
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NPI Number | 1225992894
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Entity Type | Organization
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Legal Business Name | THRIVE TRANS YOUTH SOCAL
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 3931 LONG BEACH BLVD
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City | LONG BEACH
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State | CA
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Zip | 90807-2614
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Country | US
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Telephone | 562-420-2300
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Fax | 562-262-0675
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Provider Business Mailing Address
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Address Line | 3931 LONG BEACH BLVD
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City | LONG BEACH
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State | CA
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Zip | 90807-2614
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Country | US
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Telephone | 562-420-2300
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Fax | 562-262-0675
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/CLINICIAN
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Name | MRS. BRIGITTE GISELE DUTIL
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Credential | ATR, LPCC, LMFT
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Telephone | 562-420-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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