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General NPI Number Information
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NPI Number | 1477244416
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Entity Type | Organization
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Legal Business Name | THRIVE THERAPY & WELLNESS
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 505 NE EVERGREEN AVE
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City | DALLAS
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State | OR
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Zip | 97338-9121
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Country | US
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Telephone | 503-383-1422
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Fax |
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Provider Business Mailing Address
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Address Line | 2755 COMMERCIAL ST SE STE 101-227
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City | SALEM
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State | OR
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Zip | 97302-4981
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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 | OWNER
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Name | HANNA BOSSE SIMOVIC
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Credential | LPC
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Telephone | 503-383-1422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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