Basic Information
| Provider Information | |||||||||
| NPI: | 1760133078 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THRIVERY THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1233 | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488051233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437459540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 HULETT RD | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488642512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437459540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2022 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | GERMAINE | ||||||||
| AuthorizedOfficialFirstName: | DANIELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4437459540 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.