Provider Demographics
NPI:1730698598
Name:THRIVE THERAPY AND INTEGRATED WELLNESS, LLC
Entity type:Organization
Organization Name:THRIVE THERAPY AND INTEGRATED WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTRUBANIC
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ICAC, MAC
Authorized Official - Phone:260-223-4613
Mailing Address - Street 1:7925 WELSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-8703
Mailing Address - Country:US
Mailing Address - Phone:260-223-4613
Mailing Address - Fax:
Practice Address - Street 1:2420 N COLISEUM BLVD STE 206
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-3139
Practice Address - Country:US
Practice Address - Phone:260-223-4613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty