Provider Demographics
NPI:1245969336
Name:MHTHRIVE, PLLC
Entity type:Organization
Organization Name:MHTHRIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAZZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LMFT
Authorized Official - Phone:800-685-9796
Mailing Address - Street 1:1345 SPACE PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3469
Mailing Address - Country:US
Mailing Address - Phone:800-685-9796
Mailing Address - Fax:281-333-0221
Practice Address - Street 1:1345 SPACE PARK DR STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3469
Practice Address - Country:US
Practice Address - Phone:800-685-9796
Practice Address - Fax:281-333-0221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW DIMENSIONS DAY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-06
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)