| Thriveworks Clinical - Wisconsin | |
|
2920 S Webster Ave Ste E Green Bay WI 54301-1594 | |
| (855) 284-7483 | |
| Not Available |
| Full Name | Thriveworks Clinical - Wisconsin |
|---|---|
| Speciality | Counselor |
| Location | 2920 S Webster Ave Ste E, Green Bay, Wisconsin |
| Authorized Official Name and Position | Anthony Centore (CEO) |
| Authorized Official Contact | 5402176461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thriveworks Clinical - Wisconsin 1000 Jefferson St Ste 2c Lynchburg VA 24504-1724 Ph: (540) 217-6461 | Thriveworks Clinical - Wisconsin 2920 S Webster Ave Ste E Green Bay WI 54301-1594 Ph: (855) 284-7483 |
| NPI Number | 1023786076 |
|---|---|
| Provider Enumeration Date | 09/03/2021 |
| Last Update Date | 07/12/2022 |
| Certification Date | 07/12/2022 |
| Medicare PECOS PAC ID | 9234506130 |
|---|---|
| Medicare Enrollment ID | O20221107001240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023786076 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Graig A Aders |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265758734 PECOS PAC ID: 3971766049 Enrollment ID: I20120530000266 |
| Provider Name | Amie Nicole Towne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093749327 PECOS PAC ID: 6002868395 Enrollment ID: I20200220000261 |
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