MEDICARE: THRIVE PSYCHIATRIC SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1376253476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE PSYCHIATRIC SERVICES

Provider Business Mailing Address
First Line	:	304 S JONES BLVD STE 3501
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2623
Country	:	US
Telephone Number	:	775-233-5409
Fax Number	:	702-442-2121

Provider Business Practice Location Address
First Line	:	1500 E TROPICANA AVE STE 173
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8317
Country	:	US
Telephone Number	:	775-233-5409
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MUKWEL AIYUK
Credential	:	DNP
Telephone Number	:	775-233-5409

Provider Enumeration Date	:	11/29/2022
Last Update Date	:	06/30/2023

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