Provider Demographics
NPI:1689292963
Name:THRIVE BEHAVIORAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:THRIVE BEHAVIORAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:KAELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:724-766-9405
Mailing Address - Street 1:6936 MEDICAL VIEW LN
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-6602
Mailing Address - Country:US
Mailing Address - Phone:724-766-9405
Mailing Address - Fax:
Practice Address - Street 1:6936 MEDICAL VIEW LN
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6602
Practice Address - Country:US
Practice Address - Phone:724-766-9405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty