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1265273122
LATYTEAUNA GOODWIN
SHREVEPORT, LA
NPI
1265273122
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)
Enumeration Date
2024-06-04
Last Update Date
2024-06-04
Business Address
LATYTEAUNA GOODWIN
404 HEARNE AVE
SHREVEPORT, LA 71103-2022
Phone number: 318-716-1369
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Mailing Address
LATYTEAUNA GOODWIN
404 HEARNE AVE
SHREVEPORT, LA 71103-2022
Phone number: 318-716-1369
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