MEDICARE: GREEN BAKERS IS THE PLACE TO BE

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	:	1154292514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN BAKERS IS THE PLACE TO BE

Provider Business Mailing Address
First Line	:	1818 W FULTON ST STE 201A
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-4347
Country	:	US
Telephone Number	:	605-858-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 W FULTON ST STE 201A
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-4347
Country	:	US
Telephone Number	:	605-858-2700
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. CHANDLER BENJAMIN SUTHERLAND
Credential	:
Telephone Number	:	605-858-2700

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	09/17/2025

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