Provider Demographics
NPI:1003673377
Name:THRIVE FEARLESSLY COUNSELING
Entity type:Organization
Organization Name:THRIVE FEARLESSLY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-469-1003
Mailing Address - Street 1:5700 ETIWANDA AVE UNIT 240
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5700 ETIWANDA AVE UNIT 240
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2543
Practice Address - Country:US
Practice Address - Phone:626-469-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)