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General NPI Number Information
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NPI Number | 1992232169
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Entity Type | Organization
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Legal Business Name | THRIVING THERAPEUTIC FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4750 HAVERWOOD LN APT 4113
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City | DALLAS
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State | TX
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Zip | 75287-4234
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Country | US
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Telephone | 972-653-2207
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Fax |
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Provider Business Mailing Address
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Address Line | 4750 HAVERWOOD LN APT 4113
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City | DALLAS
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State | TX
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Zip | 75287-4234
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Country | US
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Telephone | 972-653-2207
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Fax |
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Authorized Official
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Title or Position | THERAPIST/ CEO
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Name | LESLEI MIRANDA BROWN
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Credential | LPC
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Telephone | 972-653-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 70884
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 70884
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 70884
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License Number State | TX
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