Provider Demographics
NPI:1790472397
Name:THRIVE WEST TENNESSEE
Entity Type:Organization
Organization Name:THRIVE WEST TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AYLMARIE
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:731-225-4295
Mailing Address - Street 1:108 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7592
Mailing Address - Country:US
Mailing Address - Phone:731-225-4295
Mailing Address - Fax:
Practice Address - Street 1:33 MURRAY GUARD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3610
Practice Address - Country:US
Practice Address - Phone:731-225-4295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty