Provider Demographics
NPI:1073078283
Name:THRIVE AT HOME
Entity Type:Organization
Organization Name:THRIVE AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MOEHLENPAH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:858-215-5366
Mailing Address - Street 1:12975 BROOKPRINTER PL STE 140
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-8894
Mailing Address - Country:US
Mailing Address - Phone:858-215-5366
Mailing Address - Fax:858-215-5366
Practice Address - Street 1:12975 BROOKPRINTER PL STE 140
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-8894
Practice Address - Country:US
Practice Address - Phone:858-215-5366
Practice Address - Fax:858-215-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty