Healthcare Provider Details

I. General information

NPI: 1790215044
Provider Name (Legal Business Name): HENRY LEE FORSYTHE JR. M. ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 S JEFFREY DR
BATON ROUGE LA
70816-4196
US

IV. Provider business mailing address

4110 E CARIBOU CT
BATON ROUGE LA
70814-5109
US

V. Phone/Fax

Practice location:
  • Phone: 225-361-0219
  • Fax:
Mailing address:
  • Phone: 225-362-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: