MEDICARE: PARENT PARTNERS LLC

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	261QM0850X	Adult Mental Health Clinic/Center	8790	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235640095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARENT PARTNERS LLC

Provider Business Mailing Address
First Line	:	1304 BERTRAND DR STE D5
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-9104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 BERTRAND DR STE D5
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-9104
Country	:	US
Telephone Number	:	855-452-4522
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIE MOUTON
Credential	:
Telephone Number	:	855-452-4522

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	10/19/2017

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Directions to “PARENT PARTNERS LLC ” Practice Location

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