Provider Demographics
NPI:1467214890
Name:THRIVE CHILD PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:THRIVE CHILD PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:941-416-1743
Mailing Address - Street 1:5116 LONGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-9503
Mailing Address - Country:US
Mailing Address - Phone:941-416-1743
Mailing Address - Fax:
Practice Address - Street 1:1465 S FORT HARRISON AVE STE 204
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2504
Practice Address - Country:US
Practice Address - Phone:727-746-5812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty