Provider Demographics
NPI:1407680093
Name:THRIVEMYNDXERCIZE PLLC
Entity type:Organization
Organization Name:THRIVEMYNDXERCIZE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:917-460-7005
Mailing Address - Street 1:175 PEARL ST FL 16220
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-7508
Mailing Address - Country:US
Mailing Address - Phone:917-460-7005
Mailing Address - Fax:470-381-1502
Practice Address - Street 1:175 PEARL ST FL 16220
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-7508
Practice Address - Country:US
Practice Address - Phone:917-460-7005
Practice Address - Fax:470-381-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty