Provider Demographics
NPI:1003635970
Name:THRIVING MINDS PSYCHOTHERAPY SERVICES LLC
Entity type:Organization
Organization Name:THRIVING MINDS PSYCHOTHERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DYE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMSW
Authorized Official - Phone:231-855-0210
Mailing Address - Street 1:465 S BEAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2797
Mailing Address - Country:US
Mailing Address - Phone:231-855-0210
Mailing Address - Fax:
Practice Address - Street 1:3088 SHEFFIELD ST STE A
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4290
Practice Address - Country:US
Practice Address - Phone:231-737-1212
Practice Address - Fax:231-737-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty