Provider Demographics
NPI:1851835920
Name:NEUROTHRYVE
Entity type:Organization
Organization Name:NEUROTHRYVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANI
Authorized Official - Middle Name:
Authorized Official - Last Name:NIERENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCB
Authorized Official - Phone:360-450-0150
Mailing Address - Street 1:2621 NE 134TH ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3036
Mailing Address - Country:US
Mailing Address - Phone:360-450-0140
Mailing Address - Fax:877-343-0535
Practice Address - Street 1:2621 NE 134TH ST
Practice Address - Street 2:SUITE 340
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3036
Practice Address - Country:US
Practice Address - Phone:360-450-0140
Practice Address - Fax:877-343-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60263831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty