Provider Demographics
NPI:1518710128
Name:THRIVE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:THRIVE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGOMBA-BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-498-9378
Mailing Address - Street 1:1650 W END BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5369
Mailing Address - Country:US
Mailing Address - Phone:612-477-5139
Mailing Address - Fax:813-441-8534
Practice Address - Street 1:1650 W END BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5369
Practice Address - Country:US
Practice Address - Phone:612-477-5139
Practice Address - Fax:813-441-8534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty