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General NPI Number Information
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NPI Number | 1306591052
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Entity Type | Organization
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Legal Business Name | MODERN THRIVE COUNSELING LLC
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 4610 S BILTMORE LN
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City | MADISON
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State | WI
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Zip | 53718-2152
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Country | US
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Telephone | 608-318-3194
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Fax |
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Provider Business Mailing Address
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Address Line | 3016 MIDNIGHT SUN DR
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-8814
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | AMY JULIA HARVAT
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Credential | MA
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Telephone | 608-975-7599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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