Provider Demographics
NPI:1598331738
Name:LIVE TO THRIVE MENTAL HEALTH COUNSELING, PLLC
Entity Type:Organization
Organization Name:LIVE TO THRIVE MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:845-738-0007
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:845-738-0007
Mailing Address - Fax:845-357-7700
Practice Address - Street 1:2 EXECUTIVE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-8217
Practice Address - Country:US
Practice Address - Phone:845-738-0007
Practice Address - Fax:845-357-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101200000XBehavioral Health & Social Service ProvidersDrama TherapistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty