Provider Demographics
NPI:1679210322
Name:THRIVE MIND THERAPIES LLC
Entity Type:Organization
Organization Name:THRIVE MIND THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LISW
Authorized Official - Prefix:MS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:502-851-5132
Mailing Address - Street 1:2116 FULTON AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2563
Mailing Address - Country:US
Mailing Address - Phone:502-851-5132
Mailing Address - Fax:
Practice Address - Street 1:5725 DRAGON WAY STE 206
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-4593
Practice Address - Country:US
Practice Address - Phone:502-851-5132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-15
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356832497OtherNPI INDIVIDUAL