Provider Demographics
NPI:1194519363
Name:THRIVE PSYCHOLOGICAL WELLNESS LLC
Entity type:Organization
Organization Name:THRIVE PSYCHOLOGICAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:KEZIAH
Authorized Official - Last Name:THIONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-302-1431
Mailing Address - Street 1:5441 S MACADAM AVE STE R
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6106
Mailing Address - Country:US
Mailing Address - Phone:972-302-1431
Mailing Address - Fax:
Practice Address - Street 1:5441 S MACADAM AVE STE R
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6106
Practice Address - Country:US
Practice Address - Phone:972-302-1431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty