Healthcare Provider Details

I. General information

NPI: 1679370159
Provider Name (Legal Business Name): THRIVING MINDS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E CECIL AVE STE B
NORTH EAST MD
21901-4057
US

IV. Provider business mailing address

102 E CECIL AVE STE B
NORTH EAST MD
21901-4057
US

V. Phone/Fax

Practice location:
  • Phone: 667-231-1269
  • Fax:
Mailing address:
  • Phone: 667-231-1269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. TIM DUANE GOUGH JR.
Title or Position: OWNER AND PSYCHOTHERAPIST
Credential: LCSW-C
Phone: 443-760-0068