MEDICARE: KEEP THRIVING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	261Q00000X	Clinic/Center
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1548005655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEEP THRIVING

Provider Business Mailing Address
First Line	:	2408 SAGAMORE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-1079
Country	:	US
Telephone Number	:	940-255-7665
Fax Number	:	682-334-7365

Provider Business Practice Location Address
First Line	:	2408 SAGAMORE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-1079
Country	:	US
Telephone Number	:	940-255-7665
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENDRICA ROBERTS
Credential	:	M.A, LPC, LCDC,
Telephone Number	:	918-813-8299

Provider Enumeration Date	:	06/29/2024
Last Update Date	:	01/14/2026

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