MEDICARE: THRIVE CHILD PSYCHOLOGY PLLC

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	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1467214890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE CHILD PSYCHOLOGY PLLC

Provider Business Mailing Address
First Line	:	5116 LONGFIELD RD
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61705-9503
Country	:	US
Telephone Number	:	941-416-1743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1465 S FORT HARRISON AVE STE 204
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-2504
Country	:	US
Telephone Number	:	727-746-5812
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRITTANY WADE
Credential	:	PHD
Telephone Number	:	941-416-1743

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/30/2024

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