Provider Demographics
NPI:1619669355
Name:THRIVING LIVES COUNSELING GROUP
Entity Type:Organization
Organization Name:THRIVING LIVES COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:787-960-5776
Mailing Address - Street 1:11310 S ORANGE BLOSSOM TRAIL PMB # 131
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9421
Mailing Address - Country:US
Mailing Address - Phone:689-270-4412
Mailing Address - Fax:
Practice Address - Street 1:11249 ISLE OF WATER BRIDGE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837
Practice Address - Country:US
Practice Address - Phone:689-270-4412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty