Provider Demographics
NPI:1487383808
Name:THRIVE PSYCHOLOGICAL AND CONSULTING SERVICES LLC
Entity type:Organization
Organization Name:THRIVE PSYCHOLOGICAL AND CONSULTING SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-256-7166
Mailing Address - Street 1:800 WILSON AVE RM 330
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2746
Mailing Address - Country:US
Mailing Address - Phone:715-256-7166
Mailing Address - Fax:
Practice Address - Street 1:800 WILSON AVE RM 330
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2746
Practice Address - Country:US
Practice Address - Phone:715-256-7166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1902264328OtherNPI TYPE 1