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General NPI Number Information
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NPI Number | 1730031733
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Entity Type | Organization
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Legal Business Name | PETERSON THRIVE THERAPY
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 720 N 16TH ST
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City | BOISE
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State | ID
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Zip | 83702-4007
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Country | US
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Telephone | 208-401-4786
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Fax |
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Provider Business Mailing Address
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Address Line | 12857 N ANDYS GULCH RD
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City | BOISE
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State | ID
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Zip | 83714-9423
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Country | US
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Telephone | 208-401-4786
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. JENNIFER E PETERSON
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Credential | LPC
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Telephone | 208-401-4786
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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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