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General NPI Number Information
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NPI Number | 1467251033
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Entity Type | Organization
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Legal Business Name | THRIVE-ONE80
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 3819 100TH ST SW STE 8C
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City | LAKEWOOD
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State | WA
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Zip | 98499-4477
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Country | US
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Telephone | 253-528-8951
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Fax |
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Provider Business Mailing Address
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Address Line | 18110 131ST ST E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-7696
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Country | US
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Telephone | 253-528-8951
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. PERCY LEROY STURGIS III
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Credential | LMHCA
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Telephone | 253-528-8951
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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 |
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License Number State |
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