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General NPI Number Information
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NPI Number | 1376285536
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Entity Type | Organization
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Legal Business Name | GREEN BRANCHES COUNSELING ASSOCIATES PLC
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Dates
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Enumeration Date | 04/08/2022
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 4867 E BELTLINE AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9787
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Country | US
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Telephone | 616-485-9047
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Fax |
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Provider Business Mailing Address
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Address Line | 4867 E BELTLINE AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9787
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Country | US
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Telephone | 616-485-9047
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | CHAD MICHAEL FESSENDEN
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Credential | LMSW
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Telephone | 616-485-9047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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