Provider Demographics
NPI:1760148852
Name:FLYING PIGS THRIVE THERAPY PLLC
Entity Type:Organization
Organization Name:FLYING PIGS THRIVE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-622-3259
Mailing Address - Street 1:3S101 ROCKWELL ST UNIT 1331
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3053
Mailing Address - Country:US
Mailing Address - Phone:224-622-3259
Mailing Address - Fax:
Practice Address - Street 1:30605 MCCORMICK LN
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3963
Practice Address - Country:US
Practice Address - Phone:224-622-3259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty