Provider Demographics
NPI:1891386405
Name:GRACE TO HOPE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:GRACE TO HOPE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BASILETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC LICDC
Authorized Official - Phone:330-440-8882
Mailing Address - Street 1:28000 MAYS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:TIPPECANOE
Mailing Address - State:OH
Mailing Address - Zip Code:44699-9449
Mailing Address - Country:US
Mailing Address - Phone:133-044-0259
Mailing Address - Fax:
Practice Address - Street 1:79030 FREEPORT TIPPECANOE RD SUITE A
Practice Address - Street 2:
Practice Address - City:TIPPECANOE
Practice Address - State:OH
Practice Address - Zip Code:44699
Practice Address - Country:US
Practice Address - Phone:330-440-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1770071623Medicaid