MEDICARE: THRIVE AUTHENTICALLY THERAPY LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1699625392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE AUTHENTICALLY THERAPY LLC

Provider Business Mailing Address
First Line	:	4539 N 22ND ST STE N
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4539 N 22ND ST STE N
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	917-362-2393
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	MRS. SACHEEN LAFORTEKA KING
Credential	:	LCSW
Telephone Number	:	917-362-2393

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	03/25/2026

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