Provider Demographics
NPI:1285050401
Name:THRIVE COMMUNITY MENTAL HEALTH CENTER, LLC
Entity type:Organization
Organization Name:THRIVE COMMUNITY MENTAL HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:SHEPPERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-204-3096
Mailing Address - Street 1:12700 STAFFORD RD APT 1221
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3575
Mailing Address - Country:US
Mailing Address - Phone:281-204-3096
Mailing Address - Fax:
Practice Address - Street 1:4310 AVENUE H
Practice Address - Street 2:SUITE 18
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2848
Practice Address - Country:US
Practice Address - Phone:281-204-3096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health