Healthcare Provider Details

I. General information

NPI: 1992232169
Provider Name (Legal Business Name): THRIVING THERAPEUTIC FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 HAVERWOOD LN APT 4113
DALLAS TX
75287-4234
US

IV. Provider business mailing address

4750 HAVERWOOD LN APT 4113
DALLAS TX
75287-4234
US

V. Phone/Fax

Practice location:
  • Phone: 972-653-2207
  • Fax:
Mailing address:
  • Phone: 972-653-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number70884
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number70884
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number70884
License Number StateTX

VIII. Authorized Official

Name: LESLEI MIRANDA BROWN
Title or Position: THERAPIST/ CEO
Credential: LPC
Phone: 972-653-2207