Provider Demographics
NPI:1447903893
Name:THRIVE ADVANCED CARE LLC
Entity type:Organization
Organization Name:THRIVE ADVANCED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANAYLST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIMO FOSSOUO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:214-454-2447
Mailing Address - Street 1:406 KAMBER LN
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4539
Mailing Address - Country:US
Mailing Address - Phone:214-454-2447
Mailing Address - Fax:
Practice Address - Street 1:406 KAMBER LN
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4539
Practice Address - Country:US
Practice Address - Phone:214-454-2447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty