MEDICARE: CUP WITH A TWIST OF COCOA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1487373973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUP WITH A TWIST OF COCOA

Provider Business Mailing Address
First Line	:	1324 AMBASSADOR CAFFERY PKWY
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-1814
Country	:	US
Telephone Number	:	337-366-6118
Fax Number	:	337-443-0456

Provider Business Practice Location Address
First Line	:	1324 AMBASSADOR CAFFERY PKWY
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-1814
Country	:	US
Telephone Number	:	337-366-6118
Fax Number	:	337-443-0456

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JAYMILYN GREEN
Credential	:
Telephone Number	:	337-366-6118

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	09/18/2025

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Directions to “CUP WITH A TWIST OF COCOA ” Practice Location

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