MEDICARE: THRIVE TUCSON 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	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5204658528	OTHER	CO	PHONE

General Provider Information

NPI Number	:	1922574607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE TUCSON LLC

Provider Business Mailing Address
First Line	:	1050 E RIVER RD STE 202
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-5736
Country	:	US
Telephone Number	:	520-357-0042
Fax Number	:	520-844-1014

Provider Business Practice Location Address
First Line	:	1050 E RIVER RD STE 202
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-5736
Country	:	US
Telephone Number	:	520-357-0042
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEREK VANE
Credential	:
Telephone Number	:	520-551-3150

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	01/20/2026

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Directions to “THRIVE TUCSON LLC ” Practice Location

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