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General NPI Number Information
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NPI Number | 1598122665
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Entity Type | Organization
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Legal Business Name | THRIVING PATH, LLC
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 1525 E 53RD ST SUITE #911
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City | CHICAGO
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State | IL
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Zip | 60615-4557
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Country | US
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Telephone | 847-942-6663
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Fax |
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Provider Business Mailing Address
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Address Line | 3368 S CALUMET AVE
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City | CHICAGO
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State | IL
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Zip | 60616-3934
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Country | US
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Telephone | 847-942-6663
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PSYCHOTHERAPIST
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Name | MRS. CORI R DIXON-FYLE
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Credential | LCSW
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Telephone | 847-942-6663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 149.014392
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 149.014392
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.014392
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License Number State | IL
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