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General NPI Number Information
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NPI Number | 1619496668
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Entity Type | Individual
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Provider Name | LAROCHELLE WOOTEN
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Gender | Female
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 01/06/2024
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Provider Practice Location Address
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Address Line | 645 HIGHWAY 80 E
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City | MONROE
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State | LA
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Zip | 71203-8527
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Country | US
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Telephone | 318-343-8744
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Fax |
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Provider Business Mailing Address
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Address Line | 420 MCCAIN DR
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City | MONROE
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State | LA
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Zip | 71203-4053
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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