=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457150450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIVE INTEGRATIVE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2025
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20109 DRIFTWOOD AVE
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60411-6812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-931-1769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20109 DRIFTWOOD AVE
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60411-6812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | OLAMIDE TUNDE-ALI
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 773-931-1769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------