MEDICARE: CHEYANNA GREEN-MOLETT LPC

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	6401225848	MI

General Provider Information

NPI Number	:	1508723834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEYANNA GREEN-MOLETT LPC

Provider Business Mailing Address
First Line	:	1768 BENJAMIN AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5434
Country	:	US
Telephone Number	:	248-804-7397
Fax Number	:

Provider Business Practice Location Address
First Line	:	1768 BENJAMIN AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5434
Country	:	US
Telephone Number	:	248-804-7397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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