MEDICARE: THRIVING MENTAL HEALTH 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1548986599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVING MENTAL HEALTH COUNSELING PLLC

Provider Business Mailing Address
First Line	:	8315 LEFFERTS BLVD APT 4L
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2541
Country	:	US
Telephone Number	:	192-940-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	8315 LEFFERTS BLVD APT 4L
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2541
Country	:	US
Telephone Number	:	192-940-0386
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MENTAL HEALTH COUNSELOR
Name	:	ALICIA GOMERA
Credential	:
Telephone Number	:	929-400-3868

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	10/12/2022

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