Provider Demographics
NPI:1336578426
Name:THRIVE WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:THRIVE WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SHEA
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, NCC
Authorized Official - Phone:606-875-2125
Mailing Address - Street 1:PO BOX 1693
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42502-1693
Mailing Address - Country:US
Mailing Address - Phone:606-875-2125
Mailing Address - Fax:
Practice Address - Street 1:1112 S. HWY. 27, STE. D, BOX #4
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3503
Practice Address - Country:US
Practice Address - Phone:606-875-2125
Practice Address - Fax:606-451-9624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1671251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health