Provider Demographics
NPI:1558679589
Name:COUVILLION WELLNESS, LLC
Entity Type:Organization
Organization Name:COUVILLION WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:COUVILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-787-5952
Mailing Address - Street 1:3004 JACKSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-4745
Mailing Address - Country:US
Mailing Address - Phone:318-787-5952
Mailing Address - Fax:318-787-5962
Practice Address - Street 1:3004 JACKSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-4745
Practice Address - Country:US
Practice Address - Phone:318-787-5952
Practice Address - Fax:318-787-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5969104100000X
LA04977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty