Provider Demographics
NPI:1972475036
Name:THRIVE THROUGH PLAY LLC
Entity type:Organization
Organization Name:THRIVE THROUGH PLAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAYLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WITTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PC-A
Authorized Official - Phone:773-780-1489
Mailing Address - Street 1:2051 NW NICKERNUT AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7757
Mailing Address - Country:US
Mailing Address - Phone:773-780-1489
Mailing Address - Fax:
Practice Address - Street 1:355 NE LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4555
Practice Address - Country:US
Practice Address - Phone:541-797-0748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty