Provider Demographics
NPI:1992232169
Name:THRIVING THERAPEUTIC FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:THRIVING THERAPEUTIC FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLEI
Authorized Official - Middle Name:MIRANDA
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:972-653-2207
Mailing Address - Street 1:4750 HAVERWOOD LN APT 4113
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4234
Mailing Address - Country:US
Mailing Address - Phone:972-653-2207
Mailing Address - Fax:
Practice Address - Street 1:4750 HAVERWOOD LN APT 4113
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-4234
Practice Address - Country:US
Practice Address - Phone:972-653-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70884101YM0800X, 261QM0801X
70884261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty