Provider Demographics
NPI:1053894501
Name:THRIVE PSYCHOLOGY SERVICES, LLC
Entity type:Organization
Organization Name:THRIVE PSYCHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-706-5175
Mailing Address - Street 1:3210 E 10TH ST UNIT 5163
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-2753
Mailing Address - Country:US
Mailing Address - Phone:562-706-5175
Mailing Address - Fax:
Practice Address - Street 1:4120 W DRESDEN DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-8403
Practice Address - Country:US
Practice Address - Phone:562-706-5175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty