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General NPI Number Information
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NPI Number | 1801481395
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Entity Type | Organization
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Legal Business Name | THRIVEWORKS CLINICAL - CALIFORNIA PC
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 2804 CAMINO DOS RIOS STE 206
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-1175
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Country | US
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Telephone | 855-284-7483
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 748465
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City | ATLANTA
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State | GA
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Zip | 30374-8465
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Country | US
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Telephone | 855-284-7483
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MACKENZIE JENNINGS
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Credential |
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Telephone | 617-454-4916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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