NPIMap

Organization Active NPI

Elyse Etapa LLC

Doing business as Thrive Counseling Services

  • Mental Health Counselor
  • Canton, OH
National Provider Identifier
1720517956
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
E.0900340 Issued in OH
Legal business name
ELYSE ETAPA LLC
Doing business as
Thrive Counseling Services
Practice address
4119 Whipple Ave NW Ste B
Canton, OH 44718-4801
Phone
(330) 703-6578
Fax
(330) 768-7116
NPI assigned
Jun 10, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elyse Nicole Etapa, LPCC-SNPI 1154631091
Title
Owner
Phone
(330) 703-6578

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C.1600451 OH
Mental Health Counselor 101YM0800X E.1700000 OH
Mental Health Counselor 101YM0800X E.0900340 OH Primary

Addresses

Primary practice location

4119 Whipple Ave NW Ste B
Canton, OH 44718-4801

Mailing address

4119 Whipple Ave NW Ste B
Canton, OH 44718-4801
Phone (330) 703-6578

Other identifiers 2

IdentifierTypeStateIssuer
0215799MedicaidOH
0057484MedicaidOH

Other names 1

  • Thrive Counseling Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260107003744 OH Part B Supplier - Clinic/Group Practice 6103302310 Receives reassigned benefits from 1 practitioner
Practice locations: Canton, OH

National Provider Directory

National Provider Directory

Locations

4119 Whipple Ave NW
Ste B
Canton, OH 44718
Phone (330) 703-6578

4680 Douglas Cir NW
Canton, OH 44718
Phone (330) 445-7889

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1720517956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4119 WHIPPLE AVE NW STE B",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447184801",
            "telephone_number": "330-703-6578",
            "fax_number": "330-768-7116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4119 WHIPPLE AVE NW STE B",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447184801",
            "telephone_number": "330-703-6578",
            "fax_number": "330-768-7116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELYSE ETAPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-10",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ETAPA",
        "authorized_official_first_name": "ELYSE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-703-6578",
        "authorized_official_credential": "LPCC-S"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.1600451",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.1700000",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.0900340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0215799",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0057484",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thrive Counseling Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.