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General NPI Number Information
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NPI Number | 1275417610
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Entity Type | Organization
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Legal Business Name | THRIVE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 1251 N EDDY ST STE 200
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City | SOUTH BEND
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State | IN
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Zip | 46617-1478
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Country | US
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Telephone | 574-544-9597
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Fax | 866-219-1359
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Provider Business Mailing Address
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Address Line | 55089 ARDITH ST
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City | OSCEOLA
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State | IN
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Zip | 46561-9064
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Country | US
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Telephone | 574-274-6919
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST, OWNER
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Name | DR. MATTHEW SCOTT JACKSON
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Credential | PHD
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Telephone | 574-544-9597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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