MEDICARE: THE GREEN GODDESS DOULA SERVICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1609726140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GREEN GODDESS DOULA SERVICE, LLC

Provider Business Mailing Address
First Line	:	12239 LA MARGIE AVE APT 1
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-2506
Country	:	US
Telephone Number	:	225-505-4959
Fax Number	:

Provider Business Practice Location Address
First Line	:	14423 OLD HAMMOND HWY STE I
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-1148
Country	:	US
Telephone Number	:	225-505-4959
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	E'KEIDRA LE'TIHA LANEHART
Credential	:
Telephone Number	:	225-505-4959

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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