Healthcare Provider Details

I. General information

NPI: 1679107809
Provider Name (Legal Business Name): LAUREN BENNETT HUTCHINSON CIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 HIGHWAY 956
ETHEL LA
70730-4520
US

IV. Provider business mailing address

12136 S MILSTEAD PL
BATON ROUGE LA
70818-2642
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-4144
  • Fax: 225-683-4142
Mailing address:
  • Phone: 225-281-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: