Healthcare Provider Details

I. General information

NPI: 1992013569
Provider Name (Legal Business Name): DR. RENEE' BABIN BONIN, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BEAULLIEU DR BLDG 9B-1
LAFAYETTE LA
70508-7230
US

IV. Provider business mailing address

200 BEAULLIEU DR BLDG 9B-1
LAFAYETTE LA
70508-7230
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-3483
  • Fax: 337-504-3573
Mailing address:
  • Phone: 337-504-3483
  • Fax: 337-504-3573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3642
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5048
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4398
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1224
License Number StateLA
# 6
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.0005
License Number StateLA

VIII. Authorized Official

Name: DR. RENEE BABIN BONIN
Title or Position: OWNER
Credential: PHD
Phone: 337-504-3483