MEDICARE: ETP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700681475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETP LLC

Provider Business Mailing Address
First Line	:	3053 CENTER POINT RD NE STE B
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4049
Country	:	US
Telephone Number	:	319-777-9536
Fax Number	:

Provider Business Practice Location Address
First Line	:	3053 CENTER POINT RD NE STE B
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4049
Country	:	US
Telephone Number	:	319-777-9536
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	ASHLEY WILLHITE
Credential	:
Telephone Number	:	319-777-9536

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	06/19/2025

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Directions to “ETP LLC ” Practice Location

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