Provider Demographics
NPI:1720517956
Name:ELYSE ETAPA LLC
Entity Type:Organization
Organization Name:ELYSE ETAPA LLC
Other - Org Name:THRIVE COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ETAPA
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:330-703-6578
Mailing Address - Street 1:4119 WHIPPLE AVE NW STE B
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-4801
Mailing Address - Country:US
Mailing Address - Phone:330-703-6578
Mailing Address - Fax:330-768-7116
Practice Address - Street 1:4119 WHIPPLE AVE NW STE B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-4801
Practice Address - Country:US
Practice Address - Phone:330-703-6578
Practice Address - Fax:330-768-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1600451101YM0800X
OHE.0900340101YM0800X
OHE.1700000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215799Medicaid
OH0057484Medicaid