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General NPI Number Information
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NPI Number | 1871974451
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Entity Type | Organization
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Legal Business Name | ALIVE AND THRIVING: PSYCHOLOGICAL SERVICES FOR YOUR WELL-BEING
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 11007 N 56TH ST SUITE N
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-2954
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Country | US
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Telephone | 813-982-4220
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Fax |
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Provider Business Mailing Address
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Address Line | 11007 N 56TH ST SUITE N
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-2954
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Country | US
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Telephone | 813-982-4220
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JILL C THOMAS
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Credential | PHD
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Telephone | 813-982-4220
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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 | PY9264
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License Number State | FL
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