Healthcare Provider Details

I. General information

NPI: 1477418820
Provider Name (Legal Business Name): ROOT AND THRIVE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 GENERAL TAYLOR ST
NEW ORLEANS LA
70115-5351
US

IV. Provider business mailing address

3157 GENTILLY BLVD # 6490
NEW ORLEANS LA
70122-3872
US

V. Phone/Fax

Practice location:
  • Phone: 504-290-0134
  • Fax:
Mailing address:
  • Phone: 504-290-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN BROCK
Title or Position: OWNER/MEMBER
Credential: PHD
Phone: 314-443-5892