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1962506550
JUAN MANUEL GOMEZ
SHREVEPORT, LA
NPI
1962506550
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
Enumeration Date
2006-09-12
Last Update Date
2007-07-08
Business Address
JUAN MANUEL GOMEZ
510 EAST STONER AVE
SHREVEPORT, LA 71101-4295
Phone number: 318-221-8411
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Mailing Address
JUAN MANUEL GOMEZ
102 LAKEWOOD PT
BOSSIER CITY, LA 71111-2000
Phone number: 318-742-3077
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