Provider Demographics
NPI:1386122604
Name:LIVE TO THRIVE
Entity type:Organization
Organization Name:LIVE TO THRIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:646-267-1346
Mailing Address - Street 1:16 HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1933
Mailing Address - Country:US
Mailing Address - Phone:646-267-1346
Mailing Address - Fax:
Practice Address - Street 1:4 EXECUTIVE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-8202
Practice Address - Country:US
Practice Address - Phone:646-267-1346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY007529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty