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General NPI Number Information
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NPI Number | 1295398378
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Entity Type | Organization
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Legal Business Name | THRIVE BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 516 S CLINTON ST
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City | IOWA CITY
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State | IA
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Zip | 52240-4212
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Country | US
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Telephone | 319-569-1710
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Fax |
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Provider Business Mailing Address
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Address Line | 516 S CLINTON ST
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City | IOWA CITY
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State | IA
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Zip | 52240-4212
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Country | US
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Telephone | 319-569-1710
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. LANAYA L ETHINGTON
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Credential | PHD
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Telephone | 319-569-1710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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