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General NPI Number Information
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NPI Number | 1578206363
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Entity Type | Organization
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Legal Business Name | PEGASUS THERAPY LLC
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 240 S PARKER ST
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City | MARINE CITY
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State | MI
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Zip | 48039-3592
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Country | US
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Telephone | 810-650-2732
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Fax |
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Provider Business Mailing Address
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Address Line | 5031 POINTE DR
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City | EAST CHINA
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State | MI
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Zip | 48054-3511
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Country | US
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Telephone | 810-300-6899
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | TAMARA G SHIVERS
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Credential | MA LPC NBCC
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Telephone | 810-650-2732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional 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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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