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General NPI Number Information
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NPI Number | 1144104324
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Entity Type | Organization
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Legal Business Name | GOOD MEN HEALTH, LLC
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 1545 LINE AVE STE 205
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City | SHREVEPORT
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State | LA
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Zip | 71101-4630
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Country | US
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Telephone | 318-540-5976
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Fax |
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Provider Business Mailing Address
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Address Line | 3006 PLEASANT GRV
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City | BOSSIER CITY
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State | LA
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Zip | 71111-5758
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Country | US
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Telephone | 318-216-6319
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER/FACILITATOR
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Name | MRS. SHARON DENISE JEFFERSON
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Credential | LMSW
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Telephone | 318-540-5976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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