MEDICARE: THRIVE WELLNESS CENTER, 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	103K00000X	Behavior Analyst
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1780411512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	3013 N RANCHO DR STE 128
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3349
Country	:	US
Telephone Number	:	702-490-9979
Fax Number	:

Provider Business Practice Location Address
First Line	:	3013 N RANCHO DR STE 128
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3349
Country	:	US
Telephone Number	:	702-490-9979
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KENYATTA FLETCHER
Credential	:
Telephone Number	:	702-408-9071

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	06/30/2025

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