Provider Demographics
NPI:1669011581
Name:THRIVE HOUSE THERAPY PLLC
Entity Type:Organization
Organization Name:THRIVE HOUSE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TARAN
Authorized Official - Middle Name:LANAE
Authorized Official - Last Name:MCGOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-346-1691
Mailing Address - Street 1:5000 RIVERSIDE DRIVE
Mailing Address - Street 2:BLDG 6, STE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:469-346-1691
Mailing Address - Fax:
Practice Address - Street 1:5000 RIVERSIDE DRIVE
Practice Address - Street 2:BLDG 6, STE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039
Practice Address - Country:US
Practice Address - Phone:469-346-1691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77026OtherTX LICENSE