Healthcare Provider Details

I. General information

NPI: 1992417372
Provider Name (Legal Business Name): GOOD GREEN LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 SHORT VINE ST UNIT 19608
CINCINNATI OH
45219-7525
US

IV. Provider business mailing address

31 MULBERRY ST
CINCINNATI OH
45202-8922
US

V. Phone/Fax

Practice location:
  • Phone: 513-403-7599
  • Fax:
Mailing address:
  • Phone: 513-403-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MS. TONIA DENISE CONGO REEVES SMITH
Title or Position: BUSINESS OWNER
Credential: MS, RDN, LDN
Phone: 513-403-7599