Provider Demographics
NPI:1447703863
Name:THRIVE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:THRIVE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARGREAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-230-4071
Mailing Address - Street 1:446 SAUVIGNON WAY
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-3646
Mailing Address - Country:US
Mailing Address - Phone:218-230-4071
Mailing Address - Fax:
Practice Address - Street 1:446 SAUVIGNON WAY
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736
Practice Address - Country:US
Practice Address - Phone:218-230-4071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty