Provider Demographics
NPI:1396216891
Name:THRIVE IHS INTEGRATIVE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:THRIVE IHS INTEGRATIVE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BEHAVIORAL HEALTH SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:407-963-5940
Mailing Address - Street 1:9246 REYMONT ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-3814
Mailing Address - Country:US
Mailing Address - Phone:407-963-5940
Mailing Address - Fax:
Practice Address - Street 1:101 E MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2123
Practice Address - Country:US
Practice Address - Phone:407-963-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty