Healthcare Provider Details

I. General information

NPI: 1346987542
Provider Name (Legal Business Name): CHRISTIAN NICOLE GULLETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 GRAYSON ST
WEST MONROE LA
71292-6231
US

IV. Provider business mailing address

217 ALTA MIRA DR
WEST MONROE LA
71291-9798
US

V. Phone/Fax

Practice location:
  • Phone: 318-570-5907
  • Fax:
Mailing address:
  • Phone: 318-680-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: