MEDICARE: HEATHER GREMILLION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator		LA

General Provider Information

NPI Number	:	1184081259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GREMILLION

Provider Business Mailing Address
First Line	:	806 PAOLA ST
Second Line	:
City	:	BAKER
State	:	LA
Zip	:	70714-4354
Country	:	US
Telephone Number	:	225-955-0106
Fax Number	:

Provider Business Practice Location Address
First Line	:	9420 LINDALE AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-4161
Country	:	US
Telephone Number	:	225-442-9420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	04/03/2019

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Directions to “ HEATHER GREMILLION ” Practice Location

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