# PEGASUS THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578206363
- **Authorized official:** TAMARA G SHIVERS MA LPC NBCC (THERAPIST)
- **Authorized official phone:** (810) 650-2732

## Contact information

- **Practice address:** 240 S PARKER ST, MARINE CITY, MI 48039-3592
- **Practice address phone:** (810) 650-2732
- **Mailing address:** 5031 POINTE DR, EAST CHINA, MI 48054-3511
- **Mailing address phone:** (810) 300-6899

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | Yes |

## Other

- **Enumeration date:** 04/19/2022
- **Last updated:** 05/12/2025