Provider Demographics
NPI:1912607987
Name:LICENSE TO THRIVE, LLC
Entity Type:Organization
Organization Name:LICENSE TO THRIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP, IBCLC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEAMSTER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, IBCLC
Authorized Official - Phone:361-737-8347
Mailing Address - Street 1:7601 CEDAR BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5622
Mailing Address - Country:US
Mailing Address - Phone:361-737-8347
Mailing Address - Fax:
Practice Address - Street 1:7601 CEDAR BROOK DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5622
Practice Address - Country:US
Practice Address - Phone:361-737-8347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty