=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851085724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIVE COUNSELING HEALTH & WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2023
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 WADSWORTH RD
-----------------------------------------------------
City | WADSWORTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44281-9503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-667-0260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 479 SHOREFIELD DR
-----------------------------------------------------
City | CHIPPEWA LAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44215-9721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-667-0260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KIMBERLY TUCKER SIWIK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-612-0874
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------