Healthcare Provider Details

I. General information

NPI: 1598331738
Provider Name (Legal Business Name): LIVE TO THRIVE MENTAL HEALTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EXECUTIVE BLVD STE 101
SUFFERN NY
10901-8217
US

IV. Provider business mailing address

16 HAVEN CT
NYACK NY
10960-1933
US

V. Phone/Fax

Practice location:
  • Phone: 845-738-0007
  • Fax: 845-357-7700
Mailing address:
  • Phone: 845-738-0007
  • Fax: 845-357-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. AMELIE SOUTHWOOD
Title or Position: PRESIDENT
Credential: LMHC
Phone: 845-738-0007