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General NPI Number Information
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NPI Number | 1336942853
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Entity Type | Organization
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Legal Business Name | THRIVE WELLNESS AND PERFORMANCE, LLC.
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 205 BRYCE CIR STE C
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4842
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Country | US
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Telephone | 864-420-3605
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Fax |
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Provider Business Mailing Address
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Address Line | 205 BRYCE CIR STE C
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4842
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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 | PSYCHOLOGIST AND OWNER
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Name | JAY WILES
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Credential | PSY.D.
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Telephone | 864-420-3605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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