Provider Demographics
NPI:1568067023
Name:THRIVE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:THRIVE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:509-552-9139
Mailing Address - Street 1:365 WITTERS COURT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:ID
Mailing Address - Zip Code:83555
Mailing Address - Country:US
Mailing Address - Phone:509-552-9139
Mailing Address - Fax:888-814-2380
Practice Address - Street 1:605 JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:ID
Practice Address - Zip Code:83555-5034
Practice Address - Country:US
Practice Address - Phone:509-552-9139
Practice Address - Fax:888-814-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty