Provider Demographics
NPI:1205624897
Name:THRIVE ALLY
Entity type:Organization
Organization Name:THRIVE ALLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUNTHONG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-310-5940
Mailing Address - Street 1:1634 N ALPINE RD STE 104-909
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1436
Mailing Address - Country:US
Mailing Address - Phone:815-310-5940
Mailing Address - Fax:
Practice Address - Street 1:1634 N ALPINE RD STE 104-909
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1436
Practice Address - Country:US
Practice Address - Phone:815-310-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251S00000XAgenciesCommunity/Behavioral Health