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General NPI Number Information
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NPI Number | 1700341880
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Entity Type | Individual
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Provider Name | JEFF CULLEN MONROE RAC-5049
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Gender | Male
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 10473 OLD HAMMOND HWY
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City | BATON ROUGE
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State | LA
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Zip | 70816-8264
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Country | US
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Telephone | 225-924-1910
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 HIGHWAY 956
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City | ETHEL
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State | LA
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Zip | 70730-4520
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Country | US
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Telephone | 225-683-4144
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5049
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License Number State | LA
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