Provider Demographics
NPI:1366983959
Name:THRIVE COUNSELING
Entity type:Organization
Organization Name:THRIVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROROK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:608-632-9176
Mailing Address - Street 1:114 FS DR STE A
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-2248
Mailing Address - Country:US
Mailing Address - Phone:608-632-9176
Mailing Address - Fax:608-637-8000
Practice Address - Street 1:114 FS DR STE A
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-2248
Practice Address - Country:US
Practice Address - Phone:608-632-9176
Practice Address - Fax:608-637-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5504-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1376976738Medicaid