Provider Demographics
NPI:1669038402
Name:MOUTON, BRIDGETTE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRIDGETTE
Middle Name:M
Last Name:MOUTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 BERTRAND DR STE B3
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-9102
Mailing Address - Country:US
Mailing Address - Phone:337-962-1987
Mailing Address - Fax:844-364-1683
Practice Address - Street 1:1304 BERTRAND DR STE B3
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-9102
Practice Address - Country:US
Practice Address - Phone:337-962-1987
Practice Address - Fax:844-364-1683
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA133601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical