Provider Demographics
NPI:1861027252
Name:THRIVE WEST
Entity Type:Organization
Organization Name:THRIVE WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR COUNSELING
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GENTZKOW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:971-248-2651
Mailing Address - Street 1:5635 N SCOTTSDALE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5945
Mailing Address - Country:US
Mailing Address - Phone:971-248-2651
Mailing Address - Fax:
Practice Address - Street 1:5635 N SCOTTSDALE RD STE 170
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5945
Practice Address - Country:US
Practice Address - Phone:971-248-2651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC4394Other1417493719