Provider Demographics
NPI:1962989806
Name:THRIVE BEHAVIORAL SCIENCES TAMPA LLC
Entity type:Organization
Organization Name:THRIVE BEHAVIORAL SCIENCES TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP - OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA GARDELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-277-4571
Mailing Address - Street 1:5510 N HESPERIDES ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5414
Mailing Address - Country:US
Mailing Address - Phone:813-277-4571
Mailing Address - Fax:
Practice Address - Street 1:5510 N HESPERIDES ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5414
Practice Address - Country:US
Practice Address - Phone:813-467-6111
Practice Address - Fax:813-467-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty