Provider Demographics
NPI:1467251033
Name:THRIVE-ONE80
Entity type:Organization
Organization Name:THRIVE-ONE80
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PERCY
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:III
Authorized Official - Credentials:LMHCA
Authorized Official - Phone:253-528-8951
Mailing Address - Street 1:18110 131ST ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7696
Mailing Address - Country:US
Mailing Address - Phone:253-528-8951
Mailing Address - Fax:
Practice Address - Street 1:3819 100TH ST SW STE 8C
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4477
Practice Address - Country:US
Practice Address - Phone:253-528-8951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health