Healthcare Provider Details

I. General information

NPI: 1205314952
Provider Name (Legal Business Name): SEAN BEENE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2018
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5423 SHREVE HLS N
SHREVEPORT LA
71129-3600
US

IV. Provider business mailing address

3939 LINWOOD AVE
SHREVEPORT LA
71108-2415
US

V. Phone/Fax

Practice location:
  • Phone: 318-990-1223
  • Fax:
Mailing address:
  • Phone: 318-868-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: