MEDICARE: THRIVE INTERVENTION COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1447925144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE INTERVENTION COUNSELING PLLC

Provider Business Mailing Address
First Line	:	PO BOX 143
Second Line	:
City	:	LAVON
State	:	TX
Zip	:	75166-0143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 SPRING CREEK PKWY
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-6081
Country	:	US
Telephone Number	:	214-734-5747
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR/LPC
Name	:	RASCHUNDA AUBREY
Credential	:	LPC
Telephone Number	:	214-734-5747

Provider Enumeration Date	:	08/13/2021
Last Update Date	:	08/13/2021

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