Provider Demographics
NPI:1205564978
Name:GREEN PASTURES THERAPY LLC
Entity type:Organization
Organization Name:GREEN PASTURES THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-627-8748
Mailing Address - Street 1:6046 FENTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4818
Mailing Address - Country:US
Mailing Address - Phone:810-370-0370
Mailing Address - Fax:810-603-7665
Practice Address - Street 1:6046 FENTON RD STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4818
Practice Address - Country:US
Practice Address - Phone:810-370-0370
Practice Address - Fax:810-603-7665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty