Provider Demographics
NPI:1154099620
Name:THRIVEWORKS TELEPSYCHIATRY - ILLINOIS
Entity Type:Organization
Organization Name:THRIVEWORKS TELEPSYCHIATRY - ILLINOIS
Other - Org Name:THRIVEWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CENTORE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:540-217-6461
Mailing Address - Street 1:1000 JEFFERSON ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-1724
Mailing Address - Country:US
Mailing Address - Phone:540-217-6461
Mailing Address - Fax:
Practice Address - Street 1:770 N HALSTED ST STE 201B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5999
Practice Address - Country:US
Practice Address - Phone:855-284-7483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty