Healthcare Provider Details

I. General information

NPI: 1790504314
Provider Name (Legal Business Name): BEYOND THRIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SOUTHERN AVE STE 1013
MESA AZ
85206-6201
US

IV. Provider business mailing address

11201 N TATUM BLVD STE 300
PHOENIX AZ
85028-6039
US

V. Phone/Fax

Practice location:
  • Phone: 480-878-0078
  • Fax: 480-878-0079
Mailing address:
  • Phone: 602-429-9457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL HOUCK
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LPC, LISAC
Phone: 480-878-0078