| Green Pastures Therapy Llc | |
|
6046 Fenton Rd Ste B Flint MI 48507-4818 | |
| (810) 370-0370 | |
| (810) 603-7665 |
| Full Name | Green Pastures Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 6046 Fenton Rd Ste B, Flint, Michigan |
| Authorized Official Name and Position | Michael Joseph Rose (OWNER / CLINICAL DIRECTOR) |
| Authorized Official Contact | 9896278748 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Pastures Therapy Llc 6046 Fenton Rd Ste B Flint MI 48507-4818 Ph: (810) 370-0370 | Green Pastures Therapy Llc 6046 Fenton Rd Ste B Flint MI 48507-4818 Ph: (810) 370-0370 |
| NPI Number | 1205564978 |
|---|---|
| Provider Enumeration Date | 08/10/2022 |
| Last Update Date | 08/02/2023 |
| Certification Date | 08/02/2023 |
| Medicare PECOS PAC ID | 4284019241 |
|---|---|
| Medicare Enrollment ID | O20220913000415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205564978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Michael Joseph Rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154762052 PECOS PAC ID: 2062476278 Enrollment ID: I20181017001961 |
| Provider Name | Charles Andre Mcgee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982111332 PECOS PAC ID: 9133574684 Enrollment ID: I20231018002673 |
| Provider Name | Kim T Pauwels |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710214945 PECOS PAC ID: 3274989769 Enrollment ID: I20231019000608 |
| Provider Name | Angela Marie Nicholls |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811573579 PECOS PAC ID: 4082056502 Enrollment ID: I20240529001216 |
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