Provider Demographics
NPI:1093488868
Name:THRIVE CHILD & FAMILY THERAPY CENTER PLLC
Entity Type:Organization
Organization Name:THRIVE CHILD & FAMILY THERAPY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:701-989-0210
Mailing Address - Street 1:200 E MAIN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3857
Mailing Address - Country:US
Mailing Address - Phone:701-989-0210
Mailing Address - Fax:
Practice Address - Street 1:200 E MAIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3857
Practice Address - Country:US
Practice Address - Phone:701-989-0210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND166847Medicaid