Provider Demographics
NPI:1760066633
Name:THRIVE PSYCHIATRIC & MEDICATION LLC
Entity type:Organization
Organization Name:THRIVE PSYCHIATRIC & MEDICATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-703-9942
Mailing Address - Street 1:1220 N MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-4175
Mailing Address - Country:US
Mailing Address - Phone:405-703-9942
Mailing Address - Fax:
Practice Address - Street 1:1220 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-4175
Practice Address - Country:US
Practice Address - Phone:405-703-9942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty