Basic Information
| Provider Information | |||||||||
| NPI: | 1053894501 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THRIVE PSYCHOLOGY SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3210 E 10TH ST UNIT 5163 | ||||||||
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| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474082753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627065175 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4120 W DRESDEN DR | ||||||||
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| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474048403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627065175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2018 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | KLOSTER | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5627065175 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.