MEDICARE: THRIVE COUNSELING SERVICES 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	261QM1300X	Multi-Specialty Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1912487208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	3207 SPARKS RD # 200
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-6152
Country	:	US
Telephone Number	:	307-287-8882
Fax Number	:	307-222-0279

Provider Business Practice Location Address
First Line	:	3207 SPARKS RD # 200
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-6152
Country	:	US
Telephone Number	:	307-287-8882
Fax Number	:	307-222-0279

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	LAURA KIETELL
Credential	:	LCSW
Telephone Number	:	307-369-4710

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	11/21/2025

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