| Thrive Therapy, Llc | |
|
11990 Portland Ave Burnsville MN 55337-1516 | |
| (612) 568-6050 | |
| (952) 736-8375 |
| Full Name | Thrive Therapy, Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 11990 Portland Ave, Burnsville, Minnesota |
| Authorized Official Name and Position | Ashlee Noel Secord (OWNER) |
| Authorized Official Contact | 6125686050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thrive Therapy, Llc 11990 Portland Ave Burnsville MN 55337-1516 Ph: (612) 568-6050 | Thrive Therapy, Llc 11990 Portland Ave Burnsville MN 55337-1516 Ph: (612) 568-6050 |
| NPI Number | 1073902177 |
|---|---|
| Provider Enumeration Date | 01/13/2015 |
| Last Update Date | 07/15/2022 |
| Certification Date | 07/15/2022 |
| Medicare PECOS PAC ID | 1355719287 |
|---|---|
| Medicare Enrollment ID | O20221123002081 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073902177 | NPI | - | NPPES |
| Provider Name | Ajda Kay Lommen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760724751 PECOS PAC ID: 5294970976 Enrollment ID: I20130329000059 |
| Provider Name | Dawn M Ebeling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063051639 PECOS PAC ID: 3072949007 Enrollment ID: I20200211001437 |
| Provider Name | Uhunoma Osadolor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295314391 PECOS PAC ID: 3173925823 Enrollment ID: I20210716002533 |
| Provider Name | Matthew Lee Sutera |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265897011 PECOS PAC ID: 2860838422 Enrollment ID: I20240306001973 |
| Provider Name | Ashlee Noel Secord |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1659516888 PECOS PAC ID: 4082082912 Enrollment ID: I20240306002525 |
| Provider Name | Reece Forrester |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1073799102 PECOS PAC ID: 8729452842 Enrollment ID: I20240313001512 |
Thrive Therapy, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11990 Portland Ave, Burnsville, MN 55337 Phone: 612-568-6050 Fax: 952-479-7896 | |
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