Provider Demographics
NPI:1720616766
Name:AMANDA ESTILL LLC
Entity Type:Organization
Organization Name:AMANDA ESTILL LLC
Other - Org Name:THRIVE WELLNESS COLLABORATIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTILL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:989-506-4457
Mailing Address - Street 1:119 W CASS ST UNIT 91
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-5003
Mailing Address - Country:US
Mailing Address - Phone:989-506-4457
Mailing Address - Fax:616-619-6007
Practice Address - Street 1:119 W CASS ST UNIT 91
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-5003
Practice Address - Country:US
Practice Address - Phone:989-506-4457
Practice Address - Fax:616-619-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty