Provider Demographics
NPI:1043814759
Name:BORN TO THRIVE COUNSELING, LLC
Entity Type:Organization
Organization Name:BORN TO THRIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-274-1419
Mailing Address - Street 1:635 SE JUNIPER CT E
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7853
Mailing Address - Country:US
Mailing Address - Phone:971-274-1419
Mailing Address - Fax:
Practice Address - Street 1:635 SE JUNIPER CT E
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-7853
Practice Address - Country:US
Practice Address - Phone:971-274-1419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health