Basic Information
| Provider Information | |||||||||
| NPI: | 1104066141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOUTON | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 W CONVENT ST | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705016903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375340770 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 113 W CONVENT ST | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705016903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374573000 | ||||||||
| FaxNumber: | 3374573055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2009 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 8790 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.