=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780399535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIVE & HEAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2023
-----------------------------------------------------
Last Update Date | 05/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5644 TIMBER POINT DR
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-655-7153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5644 TIMBER POINT DR
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LIC. PROFESSIONAL COUNSELOR ASSOC.
-----------------------------------------------------
Name | AYESHA SAVANT
-----------------------------------------------------
Credential | LPC-ASSOCIATE
-----------------------------------------------------
Telephone | 832-655-7153
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------