Provider Demographics
NPI:1649753286
Name:THRIVE THERAPY SCOTTSDALE
Entity Type:Organization
Organization Name:THRIVE THERAPY SCOTTSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-523-9107
Mailing Address - Street 1:4545 E SHEA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3085
Mailing Address - Country:US
Mailing Address - Phone:928-899-3969
Mailing Address - Fax:405-265-4937
Practice Address - Street 1:4545 E SHEA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3085
Practice Address - Country:US
Practice Address - Phone:928-899-3969
Practice Address - Fax:405-265-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)