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General NPI Number Information
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NPI Number | 1821789843
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Entity Type | Organization
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Legal Business Name | THRIVE NEUROPSYCHOLOGY & PSYCHOLOGY
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 3 CALIENTE RD UNIT 1
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City | SANTA FE
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State | NM
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Zip | 87508-9209
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Country | US
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Telephone | 323-620-2834
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Fax |
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Provider Business Mailing Address
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Address Line | 28 ENCANTADO RD
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City | SANTA FE
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State | NM
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Zip | 87508-1394
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Country | US
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Telephone | 323-620-2834
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOLOGIST
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Name | LARA HEFLIN
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Credential | PH.D.
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Telephone | 323-620-2834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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