=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023949534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISE AND THRIVE YOUTH WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2026
-----------------------------------------------------
Last Update Date | 05/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 PARSONS AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43206-2341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 380-282-4620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 PARSONS AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43206-2341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 380-282-4620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CERTIFIED BEHAVIORAL HEALTH SPECIAL
-----------------------------------------------------
Name | SHANNAN ENOCH
-----------------------------------------------------
Credential | CBHS
-----------------------------------------------------
Telephone | 380-282-4620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------