Healthcare Provider Details

I. General information

NPI: 1376285536
Provider Name (Legal Business Name): GREEN BRANCHES COUNSELING ASSOCIATES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4867 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-9787
US

IV. Provider business mailing address

4867 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-9787
US

V. Phone/Fax

Practice location:
  • Phone: 616-485-9047
  • Fax:
Mailing address:
  • Phone: 616-485-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: CHAD MICHAEL FESSENDEN
Title or Position: SOLE MBR
Credential: LMSW
Phone: 616-485-9047