Provider Demographics
NPI:1790156362
Name:THRIVE BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:THRIVE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HYMEL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:410-780-5203
Mailing Address - Street 1:9627 PHILADELPHIA RD STE 160
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4157
Mailing Address - Country:US
Mailing Address - Phone:410-780-5203
Mailing Address - Fax:410-780-5205
Practice Address - Street 1:5720 EXECUTIVE DR STE 100-105
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-780-5203
Practice Address - Fax:410-780-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-1669251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4223195-02Medicaid
349970Medicare PIN