Healthcare Provider Details

I. General information

NPI: 1134989478
Provider Name (Legal Business Name): THRIVE BEHAVIORAL SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 BOONES LN
HOWARD PA
16841-1842
US

IV. Provider business mailing address

91 BOONES LN
HOWARD PA
16841-1842
US

V. Phone/Fax

Practice location:
  • Phone: 814-777-8228
  • Fax:
Mailing address:
  • Phone: 814-777-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MACKENZIE BURDETT EMEL
Title or Position: OWNER
Credential: RN
Phone: 814-777-8228