Provider Demographics
NPI:1063135085
Name:THRIVERGENT BEHAVIORAL SERVICES, LLC
Entity type:Organization
Organization Name:THRIVERGENT BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, BCBA
Authorized Official - Phone:816-888-6226
Mailing Address - Street 1:3831 FREDERICK AVE # 212
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3020
Mailing Address - Country:US
Mailing Address - Phone:816-888-6226
Mailing Address - Fax:
Practice Address - Street 1:3831 FREDERICK AVE # 212
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3020
Practice Address - Country:US
Practice Address - Phone:816-888-6226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty