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General NPI Number Information
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NPI Number | 1568694578
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Entity Type | Organization
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Legal Business Name | THRIVE THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 200 E EVERGREEN AVE STE 106
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-3240
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Country | US
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Telephone | 847-749-3807
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Fax |
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Provider Business Mailing Address
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Address Line | 200 E EVERGREEN AVE STE 106
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-3240
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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 | KATHLEEN ERIN ECCLES
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Credential |
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Telephone | 847-749-3807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 178004019
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149013183
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License Number State | IL
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