Provider Demographics
NPI:1528824109
Name:THRIVE BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:THRIVE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIZZY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:888-433-3201
Mailing Address - Street 1:108 PATRIOT DR STE A-5
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8803
Mailing Address - Country:US
Mailing Address - Phone:888-433-3201
Mailing Address - Fax:
Practice Address - Street 1:108 PATRIOT DR STE A-5
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-8803
Practice Address - Country:US
Practice Address - Phone:888-433-3201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty