Provider Demographics
NPI:1841382710
Name:ELSASS, HELEN MARIE (PC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:MARIE
Last Name:ELSASS
Suffix:
Gender:F
Credentials:PC, CRC
Other - Prefix:MS
Other - First Name:HELEN
Other - Middle Name:MARIE
Other - Last Name:FORTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PC
Mailing Address - Street 1:3825 ORION ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5643
Mailing Address - Country:US
Mailing Address - Phone:330-494-2722
Mailing Address - Fax:
Practice Address - Street 1:101 CLEVELAND AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1700
Practice Address - Country:US
Practice Address - Phone:330-454-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0006810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional