Provider Demographics
NPI:1558692764
Name:THRIVE COUNSELING GROUP, INC.
Entity Type:Organization
Organization Name:THRIVE COUNSELING GROUP, INC.
Other - Org Name:D & D COUNSELING, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LBP
Authorized Official - Phone:918-647-2262
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0055
Mailing Address - Country:US
Mailing Address - Phone:918-647-2262
Mailing Address - Fax:918-647-2282
Practice Address - Street 1:3111 B N. BROADWAY
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-0055
Practice Address - Country:US
Practice Address - Phone:918-647-2262
Practice Address - Fax:918-647-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200123440AMedicaid