Provider Demographics
NPI:1376285536
Name:GREEN BRANCHES COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:GREEN BRANCHES COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRESSENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-485-9047
Mailing Address - Street 1:920 ALPINE CHURCH NW
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8356
Mailing Address - Country:US
Mailing Address - Phone:616-485-9047
Mailing Address - Fax:
Practice Address - Street 1:920 ALPINE CHURCH NW
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8356
Practice Address - Country:US
Practice Address - Phone:616-485-9047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty