Provider Demographics
NPI:1578274387
Name:MOUTON, KAMETRIUS RENEE I
Entity Type:Individual
Prefix:MS
First Name:KAMETRIUS
Middle Name:RENEE
Last Name:MOUTON
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGH MEADOWS BVLD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507
Mailing Address - Country:US
Mailing Address - Phone:337-849-1382
Mailing Address - Fax:
Practice Address - Street 1:400 RICHARD ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-6039
Practice Address - Country:US
Practice Address - Phone:337-332-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor