Healthcare Provider Details

I. General information

NPI: 1144742248
Provider Name (Legal Business Name): GUIDANCE FOR BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 07/21/2022
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 STUBBS AVE STE B
MONROE LA
71201-5631
US

IV. Provider business mailing address

1204 STUBBS AVE STE B
MONROE LA
71201-5631
US

V. Phone/Fax

Practice location:
  • Phone: 318-582-5633
  • Fax: 318-582-5646
Mailing address:
  • Phone: 318-582-5633
  • Fax: 318-582-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2203783384
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. RODERICK T WILLIAMS JR.
Title or Position: CEO
Credential:
Phone: 318-582-5633