| Thrive Therapy Services | |
|
3200 Sheridan Rd Ste 104 Kenosha WI 53140-1921 | |
| (262) 997-9411 | |
| (262) 997-3844 |
| Full Name | Thrive Therapy Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3200 Sheridan Rd Ste 104, Kenosha, Wisconsin |
| Authorized Official Name and Position | Sandra Eiler (CLINIC DIRECTOR) |
| Authorized Official Contact | 2629979411 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thrive Therapy Services Po Box 488 Bristol WI 53104-0488 Ph: (262) 997-9411 | Thrive Therapy Services 3200 Sheridan Rd Ste 104 Kenosha WI 53140-1921 Ph: (262) 997-9411 |
| NPI Number | 1922557800 |
|---|---|
| Provider Enumeration Date | 10/03/2016 |
| Last Update Date | 01/04/2024 |
| Certification Date | 01/04/2024 |
| Medicare PECOS PAC ID | 2062749815 |
|---|---|
| Medicare Enrollment ID | O20190816000698 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922557800 | NPI | - | NPPES |
| 1922557800 | Other | NPI (TYPE 2) | |
| 100032629 | Medicaid | WI | |
| 100247525 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 5926-125 (Wisconsin) | Primary |
| Provider Name | James R Hammond |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376755397 PECOS PAC ID: 5890860456 Enrollment ID: I20090408000647 |
| Provider Name | Kenna Ruth Pomeroy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346469384 PECOS PAC ID: 2860841749 Enrollment ID: I20231218003189 |
| Provider Name | Darren Michael Porter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336462068 PECOS PAC ID: 5890148621 Enrollment ID: I20240129002833 |
| Provider Name | Sandra Eiler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275975807 PECOS PAC ID: 0143557991 Enrollment ID: I20240226002856 |
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