Provider Demographics
NPI:1710388913
Name:THRIVING MINDS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:THRIVING MINDS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTRBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:810-225-3417
Mailing Address - Street 1:10327 GRAND RIVER RD
Mailing Address - Street 2:STE. 406
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6500
Mailing Address - Country:US
Mailing Address - Phone:810-225-3417
Mailing Address - Fax:
Practice Address - Street 1:10327 GRAND RIVER RD
Practice Address - Street 2:STE. 406
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6500
Practice Address - Country:US
Practice Address - Phone:810-225-3417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1033328166103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty