Provider Information for 1104066141
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JULIE MOUTON LCSW
Sex: Female
NPI: 1104066141
Last Updated: 2023-12-28
Certification Date: 2023-12-28
Certification Date: 2023-12-28
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1104066141 | ||||||||||||
| Enumeration Date | 2009-03-04 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 113 W CONVENT ST LAFAYETTE, LA 70501-6903 United States Phone: 337-534-0770 | Fax: | ||||||||||||
| Primary Practice Address | 113 W CONVENT ST LAFAYETTE, LA 70501-6903 United States Phone: 337-457-3000 | Fax:337-457-3055 | ||||||||||||
| Secondary Practice Address(es) | 1304 BERTRAND DR STE D5 5522 LONE STAR PKWY STE 303 | ||||||||||||
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