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General NPI Number Information
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NPI Number | 1518679141
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Entity Type | Organization
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Legal Business Name | GREEN PASTURES MENTAL CARE PLLC
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 4358 LOCKHILL SELMA RD STE 307
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City | SHAVANO PARK
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State | TX
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Zip | 78249-4167
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Country | US
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Telephone | 210-940-0540
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Fax |
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Provider Business Mailing Address
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Address Line | 12370 POTRANCO RD STE 207
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City | SAN ANTONIO
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State | TX
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Zip | 78253-4260
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SARAH CASOLA
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Credential | PMHNP-BC
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Telephone | 210-940-0540
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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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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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