Basic Information
| Provider Information | |||||||||
| NPI: | 1770252611 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THRIVE MENTAL HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2252 SAMUEL COLT CT | ||||||||
| Address2: | |||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012436933 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 PROSPECTOR AVE # 28 | ||||||||
| Address2: | |||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012436933 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2021 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | BONILLA | ||||||||
| AuthorizedOfficialFirstName: | RODOLFO | ||||||||
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| AuthorizedOfficialTitleorPosition: | LCSW | ||||||||
| AuthorizedOfficialTelephone: | 8012436933 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.