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General NPI Number Information
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NPI Number | 1336578426
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Entity Type | Organization
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Legal Business Name | THRIVE WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 1112 S. HWY. 27, STE. D, BOX #4
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City | SOMERSET
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State | KY
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Zip | 42501-3503
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Country | US
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Telephone | 606-875-2125
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Fax | 606-451-9624
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Provider Business Mailing Address
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Address Line | PO BOX 1693
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City | SOMERSET
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State | KY
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Zip | 42502-1693
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Country | US
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Telephone | 606-875-2125
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. KELLY SHEA MITCHELL
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Credential | LPCC, NCC
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Telephone | 606-875-2125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1671
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License Number State | KY
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