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General NPI Number Information
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NPI Number | 1760925101
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Entity Type | Organization
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Legal Business Name | THRIVE FAMILY COUNSELING, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/01/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 4405 W RIVERSIDE DR SUITE 209
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City | BURBANK
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State | CA
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Zip | 91505-4072
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Country | US
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Telephone | 323-652-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 4405 W RIVERSIDE DR SUITE 209
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City | BURBANK
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State | CA
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Zip | 91505-4072
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Country | US
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Telephone | 323-652-2525
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. BEVERLY HANSEN WEISBLATT
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Credential | LMFT
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Telephone | 323-652-2525
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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 | 86781
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License Number State | CA
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