MEDICARE: PETERSON THRIVE THERAPY

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1730031733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSON THRIVE THERAPY

Provider Business Mailing Address
First Line	:	12857 N ANDYS GULCH RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83714-9423
Country	:	US
Telephone Number	:	208-401-4786
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 N 16TH ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-4007
Country	:	US
Telephone Number	:	208-401-4786
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MRS. JENNIFER E PETERSON
Credential	:	LPC
Telephone Number	:	208-401-4786

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “PETERSON THRIVE THERAPY ” Practice Location

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