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General NPI Number Information
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NPI Number | 1952723538
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Entity Type | Organization
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Legal Business Name | THRIVE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 1101 BROADWAY ST STE 230
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City | VANCOUVER
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State | WA
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Zip | 98660-3320
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Country | US
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Telephone | 360-719-2852
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Fax | 888-808-8143
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Provider Business Mailing Address
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Address Line | 1101 BROADWAY ST STE 230
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City | VANCOUVER
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State | WA
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Zip | 98660-3320
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Country | US
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Telephone |
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Fax | 888-808-8143
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Authorized Official
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Title or Position | PRESIDENT/LICENSED PSYCHOLOGIST
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Name | AMANDA V WEATHERBY
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Credential | PH.D.
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Telephone | 360-719-2852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00002510
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY00003931
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License Number State | WA
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