Thrive Mental Wellness, PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

THRIVE MENTAL WELLNESS, PLLC

Practice address

13508 Julie Dr
Poplar Grove, IL 61065-7829

Phone

(815) 596-0098

NPI assigned

Apr 23, 2025

Last updated

Apr 27, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Courtney Nicolle FormanNPI 1376099127

Title

Owner

Phone

(815) 209-8486

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Courtney Nicolle Forman, PMHNP-BC, FNP-C, FPA

  • Nurse Practitioner
  • Rockford, IL
  • NPI 1376099127

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD Authorized official
• Olasumbo Olubunmi Abegunde, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • San Antonio, TX
  • NPI 1497458145

  IL

  Medicare reassignment Care Compare group NPD
• Marisol Schroeder

  • Social Worker
  • Aurora, IL
  • NPI 1174904718
  Medicare reassignment Care Compare group
• Gina Fernando

  • Psychiatric/Mental Health Nurse Practitioner
  • Rockford, IL
  • NPI 1750907861
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745712000000",
    "number": "1447047469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13508 JULIE DR",
            "city": "POPLAR GROVE",
            "state": "IL",
            "postal_code": "610657829",
            "telephone_number": "815-596-0098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13508 JULIE DR",
            "city": "POPLAR GROVE",
            "state": "IL",
            "postal_code": "610657829",
            "telephone_number": "815-596-0098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIVE MENTAL WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-23",
        "last_updated": "2025-04-27",
        "certification_date": "2025-04-27",
        "status": "A",
        "authorized_official_last_name": "FORMAN",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "NICOLLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-209-8486"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER",
            "identifier": "1376099127",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Schwenk, DDS
• Taylor Siracusa
• Tila Smith, LPN
• Amber Suarez-Christensen
• David Tartaglia, DDS
• Heather Tomaino
• Drew Michael Wallace, ATC
• Tara Whitecotton, LCSW
• Taylor Woletz

• Psychiatric/Mental Health Nurse Practitioner in Poplar Grove, IL
• Providers in Poplar Grove, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.