Basic Information
| Provider Information | |||||||||
| NPI: | 1144742248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUIDANCE FOR BEHAVIORAL HEALTH, LLC | ||||||||
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| OtherOrganizationName: | GUIDANCE FOR BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1204 STUBBS AVE STE B | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185825633 | ||||||||
| FaxNumber: | 3185825646 | ||||||||
| Practice Location | |||||||||
| Address1: | 1204 STUBBS AVE STE B | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185825633 | ||||||||
| FaxNumber: | 3185825646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | RODERICK | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3185825633 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 251S00000X | 2203783384 | LA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 2203783384 | 05 | LA | MEDICAID |