| Thrive Mental Wellness, PLLC | |
|
13508 Julie Dr Poplar Grove IL 61065-7829 | |
| (815) 596-0098 | |
| Not Available |
| Full Name | Thrive Mental Wellness, PLLC |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 13508 Julie Dr, Poplar Grove, Illinois |
| Authorized Official Name and Position | Courtney Nicolle Forman (OWNER) |
| Authorized Official Contact | 8152098486 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thrive Mental Wellness, PLLC 13508 Julie Dr Poplar Grove IL 61065-7829 Ph: (815) 596-0098 | Thrive Mental Wellness, PLLC 13508 Julie Dr Poplar Grove IL 61065-7829 Ph: (815) 596-0098 |
| NPI Number | 1447047469 |
|---|---|
| Provider Enumeration Date | 04/23/2025 |
| Last Update Date | 04/27/2025 |
| Certification Date | 04/27/2025 |
| Medicare PECOS PAC ID | 2860991627 |
|---|---|
| Medicare Enrollment ID | O20250819000234 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447047469 | NPI | - | NPPES |
| 1376099127 | Other | IL | OTHER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | () | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | () | Primary |
| Provider Name | Courtney Forman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376099127 PECOS PAC ID: 0042507220 Enrollment ID: I20161003001862 |
| Provider Name | Gina M Fernando |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750907861 PECOS PAC ID: 8224456587 Enrollment ID: I20200918000034 |
| Provider Name | Marisol Reyes Schroeder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174904718 PECOS PAC ID: 0941629778 Enrollment ID: I20200929000971 |
| Provider Name | Olasumbo Olubunmi Abegunde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497458145 PECOS PAC ID: 5799270088 Enrollment ID: I20251224000194 |
Generations Dental Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13510 Julie Dr, Poplar Grove, IL 61065 Phone: 815-765-9900 Fax: 815-765-9901 |