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General NPI Number Information
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NPI Number | 1255186284
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Entity Type | Organization
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Legal Business Name | THRIVE TRAUMA THERAPY PLLC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 319 PARK ST
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City | PLAINWELL
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State | MI
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Zip | 49080-1655
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Country | US
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Telephone | 269-355-8045
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Fax | 855-632-2869
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Provider Business Mailing Address
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Address Line | 319 PARK ST
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City | PLAINWELL
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State | MI
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Zip | 49080-1655
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Country | US
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Telephone | 269-355-8045
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Fax | 855-632-2869
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Authorized Official
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Title or Position | LMSW-C/THERAPIST
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Name | JEANETTE KIEVIT
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Credential |
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Telephone | 269-355-8045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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